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Hantavirus Cardiopulmonary Syndrome Treatment & Management

  • Author: Juliet D Caldwell, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
 
Updated: Apr 01, 2015
 

Prehospital Care

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

  • Early but judicious use of 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 is indicated if the diagnosis is suspected.
  • 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, skilled resuscitation with judicious use of fluids and early institution of pressors, as well as transfer to an ICU, are paramount.[38] 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.[39, 40]

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.[27]

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[27] added 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. ECMO has been used with reported success in a number of institutions,[37, 41] although no randomized controlled studies exist. ECMO has been implemented in patients thought “likely to die,” with a reported success of achieving a 50% mortality rate. An important criterion for implementation of this rescue therapy has been demonstration of severely depressed myocardial function. Vascular surgery consult 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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Barry J Sheridan, DO Chief Warrior in Transition 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.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician, Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Palmetto Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, South Carolina Medical Association, Columbia Medical Society, South Carolina College of Emergency Physicians, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Chief Editor for Medscape.

Acknowledgements

Scott Cameron, MD Consulting Staff, Department of Emergency Medicine, Regions Hospital

Disclosure: Nothing to disclose.

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.

Maureen Gang, MD Assistant Professor, Department of Emergency Medicine, New York University Medical Center

Disclosure: Nothing to disclose.

Mana Lumumba Kasongo, MD, MS Consulting Staff, Southwest Emergency Physicians

Disclosure: Nothing to disclose.

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