Hantavirus Cardiopulmonary Syndrome Treatment & Management
- Author: Juliet D Caldwell, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD more...
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.
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. 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.
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 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.
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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