Key Clinical Message: Administration of intravenous reteplase might be a choice of treatment of acute ischemic stroke.

The primary purpose of this study is to report the experience on the extracorporeal membrane oxygenation (ECMO) process for patients in the critical care unit (CCU) of an emergency department of a tertiary hospital in Turkey, from cannulation to decannulation, including follow-up procedures. This retrospective and observational study included eight patients who received ECMO from January 2018 to January 2020. We evaluated the demographics, indications for ECMO, laboratory values, Respiratory ECMO Survival Prediction, Survival After Veno-Arterial ECMO and ECMO net scores, the management process, and patient outcomes. Blood gas analyses done after the first hour of ECMO initiation and the reevaluation of the patients’ Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores in the 24th hour of ECMO were recorded. The mean age was 52.7 ± 14.2 years. The median duration of the ECMO run was 81 (min–max: 4–267) h, and the mean length of CCU stay was 10.2 ± 6.7 days. Of the 8 patients studied, 5 (62.5%) had veno-arterial and 3 (37.5%) had veno-venous ECMO. Three patients were successfully weaned (37.5%). The overall survival-to-discharge rate was 25%. Carbon dioxide levels were significantly decreased 1 h after ECMO initiation (P = 0.038) as well as the need for vasopressors. Lactate levels were lower in decannulated patients. Changes in the APACHE II score were more consistent with the clinical deterioration in patients than SOFA score changes were. In the early phase of ECMO, vital signs improve, and the need for vasopressors and carbon dioxide levels decrease. Thus, CCUs in Emergency Departments with ECMO capabilities could potentially be designed, and emergency department ECMO algorithms could be tailored for critically ill patients in addition to out-of-hospital cardiac arrest patients.

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Introduction: Digoxin overdose, which may cause rhythm disturbances, such as atrioventricular blocks, can ultimately cause cardiac arrest. Extracorporeal life support may provide time until specific antidotes show an effect. Case Report: A 75-year-old male patient presented with dyspnea with a known history of congestive heart failure. His medications included digoxin, and his initial electrocardiography showed an idioventricular rhythm. His digoxin level was over the upper normal limit, and he had hyperkalemia (7.9 Meq/L). The patient collapsed during conventional therapies, including insulin-glucose infusion, atropine administration, and catheterization for emergency hemodialysis, and while awaiting digoxin-specific fragment antibodies. During mechanical cardiopulmonary resuscitation, the patient was awake and had a Full Outline of Unresponsiveness score of 8, which led us to initiate veno-arterial extracorporeal membrane oxygenation. Conclusion: Extracorporeal Cardiopulmonary Resuscitation, might be a useful option for intoxicated patients when conventional therapies fail. However, more experience is needed for the increase in survival rate.