ABSTRACT Background Acute nicotine intoxication can cause cardiac arrest. We report a case of cardiac arrest managed with veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) alongside serial serum nicotine monitoring. Case Presentation A 36‐year‐old woman collapsed after ingesting an unknown amount of liquid nicotine, up to 20 g. Emergency medical services found her in cardiac arrest with pulseless electrical activity (PEA). On arrival, she remained in cardiac arrest with PEA/asystole and severe acidosis, and VA‐ECMO was established 82 min after ingestion. Cardiac function gradually improved, and VA‐ECMO was discontinued on Day 3. However, she died on Day 28 from post‐cardiac arrest brain injury. Liquid chromatography–mass spectrometry (LC/MS) revealed an admission serum nicotine concentration of 6.44 μg/mL, declining to 0.057 μg/mL within 18 h. This decline paralleled hemodynamic recovery. Conclusion Although neurological outcome was unfavorable, VA‐ECMO may provide temporary circulatory support during the toxic phase of massive nicotine intoxication.
ABSTRACT Background Influenza‐induced rhabdomyolysis is an uncommon but serious complication that can cause life‐threatening hyperkalemia. The use of venoarterial extracorporeal membrane oxygenation (VA‐ECMO) for hyperkalemic cardiac arrest has rarely been described. Case Presentation A 48‐year‐old woman with influenza A developed severe rhabdomyolysis (creatine kinase: 255,240 U/L) and progressive hyperkalemia despite improved renal function and continuous renal replacement therapy. On hospital day 3, the patient experienced a hyperkalemic cardiac arrest and VA‐ECMO was initiated after 29 min of low‐flow time. Treatment for hyperkalemia was continued, and cardiac function gradually recovered, allowing the removal of ECMO on day 8. However, she later developed hemorrhagic complications related to mechanical circulatory support and died on hospital day 89. Conclusion Influenza‐induced rhabdomyolysis can cause rapid, life‐threatening hyperkalemia, even in patients with improving renal function. Temporary mechanical circulatory support may serve as a bridge through the acute reversible phase, and device‐related complications should be considered.
ABSTRACT Introduction To describe the characteristics and outcomes of sports‐related out‐of‐hospital cardiac arrest (OHCA) due to external causes, including commotio cordis, during school‐supervised sports activities in Japan's elementary schools, junior high schools, high schools, and technical colleges. Methods OHCA data (2008–2022) were obtained from the Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS)—a nationwide database of OHCAs occurring under school supervision across Japan. We identified sports‐related OHCAs with external causes and summarized patients' characteristics, bystander interventions, available response intervals, and survival outcomes. Results We identified 30 sports‐related OHCA cases due to external causes. The most frequently played sports were soccer/futsal ( n = 8), baseball ( n = 8), and swimming ( n = 4). The leading etiology was commotio cordis ( n = 15), followed by drowning ( n = 8). Among the 15 cases meeting our operational definition of commotio cordis, automated external defibrillator (AED) pads were applied in 14 (93%), shocks were delivered in 13 (87%), and 12 (80%) achieved a favorable neurological outcome. Among other external causes ( n = 15), ventricular fibrillation occurred in 4/15 (27%), AED pads were applied in 7/15 (47%), shocks were rare (1/15, 7%), and 1/15 (7%) achieved favorable neurological outcomes. Conclusions Nationwide case‐level reconstruction revealed distinct mechanism‐to‐response pathways. Although these descriptive data cannot establish the causal effects of the public access defibrillation programs or other interventions on outcomes, they highlight potentially actionable, mechanism‐specific opportunities for emergency response and prevention.
ABSTRACT Background Hypocalcemia is commonly monitored as a severity marker in acute pancreatitis, whereas hypercalcemia is an uncommon but important clue to primary hyperparathyroidism (PHPT). Case Presentation A 42‐year‐old man without gallstones, tumor, or alcohol use developed severe acute pancreatitis, with organ failure persisting beyond 48 h. His corrected calcium level was at the lower reference limit on admission but rose from Day 3, exceeded the upper reference limit on Day 4, and reached a peak of 18 mg/dL on Day 21. Intact parathyroid hormone was elevated, and cervical ultrasonography showed a parathyroid mass. PHPT was diagnosed on Day 24. Severe hypercalcemia with concomitant renal dysfunction required continuous hemodiafiltration, cinacalcet, elcatonin, and zoledronic acid. Parathyroidectomy on Day 35 confirmed parathyroid adenoma, and serum calcium normalized on Day 36. He required drainage of intra‐abdominal abscesses and was transferred for rehabilitation on Day 170. Conclusion In patients with severe acute pancreatitis, a calcium level that is not elevated on admission does not exclude PHPT. A rise in serum calcium during the clinical course can be an important diagnostic clue prompting re‐evaluation for PHPT.
