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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: extracorporeal membrane oxygenation

Percutaneous mechanical support in acute coronary syndromes

Abstract

Despite advances in interventional cardiology, persistently disappointing outcomes in patients with cardiogenic shock complicating myocardial infarction, together with the lack of evidence the that intra-aortic balloon pump improves outcomes in this patient population have led to a re-evaluation of other types of mechanical circulatory support. The increase in extracorporeal membrane oxygenation (ECMO) prompted by the H1N1 pandemic led to an increase in experience in using this technique in critically ill adult patients, and its use is now expanding in both respiratory and cardiac failure. Despite enthusiasm for the technique, high-quality evidence is lacking for its benefit. Nonetheless, ECMO and other types of percutaneous mechanical circulatory support do provide critical care clinicians with new supportive therapies that may prove to benefit patients, both from the high level of support that can be offered, and also minimising the use of potentially toxic inotropic agents.

Key words: cardiogenic shock, heart failure, mechanical circulatory support, extracorporeal membrane oxygenation, ECMO, myocardial infarction, acute coronary syndromes

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Lung replacement therapies for acute respiratory failure

Abstract

Acute respiratory failure is one of the critical conditions with an increased mortality. In order to reverse lung injury and reduce the mortality rate, several lung replacement therapies have been developed, including the extracorporeal membrane oxygenation, the intravascular oxygenator and carbon dioxide removal device, the intravenous membrane oxygenator and the thoracic artificial lung. This article aims to present the properties, indications and advantages of these devices.

Key words: artificial organs, extracorporeal membrane oxygenation, respiratory insufficiency

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Safety in the neonatal and infant transport system: report on three cases with evidence-based comments on safety during transportation

Abstract

Infant transport has been carried out in Slovenia since 1976. Applying the principles of safe transport was essential to avoid unexpected exposure of critically ill infants to unnecessary and adverse events. Besides organizational and technical prerequisites for safe transportation, evidence-based clinical knowledge and practical competence are of utmost importance. Furthermore, the ongoing possibility of consulting other colleagues during transportation, choose the optimal form of retrieval of very sick infants, is sometimes needed and preferred. Three different cases are presented here where skilled medical teams decided how to transport critically ill infants, and at what risks and costs. All three transports were successfully completed with good outcomes despite difficult clinical conditions prior to and during retrieval.

Key words: safety, neonatal transport, pneumothorax, prostaglandin infusion, extracorporeal membrane oxygenation

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Rapid-response extracorporeal membrane oxygenation to support failed conventional cardiopulmonary resuscitation (E-CPR) in children – case reports and literature review

Abstract

The use of extracorporeal membrane oxygenation (ECMO) to support failed conventional cardiopulmonary resuscitation e.g. ECMO cardiopulmonary resuscitation (E-CPR) in children has been increasing. We report on the first three patients in whom E-CPR was used at our institution, a low volume surgical centre. Patient’s diagnoses were: influenza B myocarditis, truncus arteriosus two days after complete surgical repair and cardiogenic shock during adenovirus infection with a discovered recoarctation of the aorta. The use of E-CPR rescued 1 patient (33%) out of three. Apart from high volume surgical centres, E-CPR can also be implemented in low volume centres with a trained in-house ECMO team, in selected cases.

Key words: cardiopulmonary resuscitation, child, extracorporeal membrane oxygenation, refractory cardiac arrest

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