{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:00:58Z","timestamp":1777478458595,"version":"3.51.4"},"reference-count":17,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,6,2]],"date-time":"2022-06-02T00:00:00Z","timestamp":1654128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>A 46-year-old woman demonstrated refractory Kounis syndrome (KS) after induction of anesthesia. Despite conventional management of anaphylaxis and advanced cardiac life support, her cardiovascular function continued to deteriorate until she had a cardiac arrest, and after extracorporeal membrane oxygenation (ECMO) therapy, electrical cardiac activity reappeared. A large number of patients with KS\u2014\u201callergic angina syndrome\u201d\u2014has been known to recover well with vasodilators; however, this patient showed antibiotics-induced refractory KS during general anesthesia. Severe bronchospasms with desaturation appeared as initial anaphylactic features; however, these did not respond to conventional treatment for anaphylaxis. Patient\u2019s hemodynamic signs eventually worsened, leading to cardiac arrest despite ephedrine administration and chest compressions. During cardiopulmonary cerebral resuscitation, the central line was secured, and epinephrine, atropine, as well as sodium bicarbonate were administered repeatedly; nevertheless, cardiac arrest was sustained. After initiation of veno-arterial ECMO, atrial fibrillation was observed, which was later converted to sinus tachycardia by electrical cardioversions and amiodarone. Coronary angiography was performed before the patient was admitted to the intensive care unit; there were no indications of an impending cardiac arrest. The patient was discharged uneventfully owing to early use of ECMO despite the emergence of KS symptoms that were initially masked by anesthesia but later worsened abruptly.<\/jats:p>","DOI":"10.3390\/medicina58060759","type":"journal-article","created":{"date-parts":[[2022,6,2]],"date-time":"2022-06-02T11:05:02Z","timestamp":1654167902000},"page":"759","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Early Use of ECMO for Refractory Kounis Syndrome Concealed by General Anesthesia\u2014A Case Report"],"prefix":"10.3390","volume":"58","author":[{"given":"Ho Kyung","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Gyeongsang National University Changwon Hospital 11, Samjeongja-ro, Seongsan-gu, Changwon-si 51472, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miyeong","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Gyeongsang National University Changwon Hospital 11, Samjeongja-ro, Seongsan-gu, Changwon-si 51472, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soo Hee","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Gyeongsang National University Changwon Hospital 11, Samjeongja-ro, Seongsan-gu, Changwon-si 51472, Korea"},{"name":"Department of Anesthesiology and Pain Medicine, Gyeongsang National University College of Medicine, Jinju-daero 816 beon-gil, Jinju-si 52727, Korea"},{"name":"Institute of Health Sciences, Gyeongsang National University, Jinju-si 52727, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jung-Woo","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Gyeongsang National University Changwon Hospital 11, Samjeongja-ro, Seongsan-gu, Changwon-si 51472, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong-Hoon","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital 11, Samjeongja-ro, Seongsan-gu, Changwon-si 51472, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1909-664X","authenticated-orcid":false,"given":"Joung Hun","family":"Byun","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital 11, Samjeongja-ro, Seongsan-gu, Changwon-si 51472, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1292-7108","authenticated-orcid":false,"given":"Seong-Ho","family":"Ok","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Gyeongsang National University Changwon Hospital 11, Samjeongja-ro, Seongsan-gu, Changwon-si 51472, Korea"},{"name":"Department of Anesthesiology and Pain Medicine, Gyeongsang National University College of Medicine, Jinju-daero 816 beon-gil, Jinju-si 52727, Korea"},{"name":"Institute of Health Sciences, Gyeongsang National University, Jinju-si 52727, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100472","DOI":"10.1016\/j.waojou.2020.100472","article-title":"World allergy organization anaphylaxis guidance 2020","volume":"13","author":"Cardona","year":"2020","journal-title":"World Allergy Organ. 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