Hantavirus Cardiopulmonary Syndrome Treatment & Management

  • Author: Juliet D Caldwell, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 21, 2011
 

Prehospital Care

Prehospital care of Hantavirus cardiopulmonary syndrome (HCPS) is supportive.

  • Aggressive fluid resuscitation with crystalloids is indicated.
  • Administer oxygen by nasal cannula, Venturi, or nonrebreather mask.
  • Intubation is warranted for severe respiratory distress.
  • Rapid transfer to a tertiary care center with ICU and ECMO capabilities, if possible, is indicated.
  • Standard respiratory precautions for infectious agents should be followed.
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Emergency Department Care

The ED physician's main challenge and responsibility is to diagnose HCPS and to admit for close observation. Early recognition of HCPS and early implementation of hemodynamic support are associated with increased survival. In cases of advanced HCPS, aggressive resuscitation and transfer to an ICU are paramount.[32] Resuscitate the patient in the familiar ABC fashion.

Administer oxygen by facemask or nonrebreather mask.

Intubate patients with respiratory failure. It is unusual for patients to die solely from respiratory failure in centers equipped with sophisticated ventilatory support.[33, 34]

Patients’ hemodynamic statuses may deteriorate after intubation secondary to preload dependence and loss of adrenergic drive; cardiac arrest at time of intubation is not uncommon and ECMO preparations, if available, should be underway.[24]

Obtain large-bore intravenous (IV) access.

Fluid resuscitation with crystalloids is indicated for any sign of hemodynamic compromise. Because of massive capillary leakage, administer fluids judiciously and use vasoactive infusions early and liberally.

Dobutamine is the preferred inotrope, with dopamine or norepinephrine[24] added as necessary to maintain blood pressure. Patients with HCPS may require large doses of vasopressors to maintain a stable blood pressure.

If possible, avoid placing central lines in the right subclavian, the right internal jugular, and one femoral vein. These veins are used for venous access for ECMO.

Broad-spectrum antibiotics are indicated for most patients presenting with respiratory distress and fever.

Use strict universal precautions.

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Consultations

Patients with suspected or confirmed Hantavirus cardiopulmonary syndrome (HCPS) require ICU admission.

Consult a medical intensivist early.

If applicable, consult the ECMO team early. Vascular surgery is typically needed for ECMO catheter placement.

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Contributor Information and Disclosures
Author

Juliet D Caldwell, MD  Assistant Professor, Department of Emergency Medicine, Weill Cornell Medical College; Attending Physician, Department of Emergency Medicine, New York Presbyterian Hospital, Weill-Cornell Medical Center; Attending Physician, Department of Emergency Medicine, Long Island College Hospital

Juliet D Caldwell, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Michelle Ervin, MD  Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Barry J Sheridan, DO  Chief, Department of Emergency Medical Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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