Application of ECMO in pediatric heart transplantation / 器官移植

Extracorporeal membrane oxygenation (ECMO) could pump the blood from human veins to the outside of the body, oxygenate the red blood cells in an artificial environment and then return them back into the body. ECMO could replace the heart and lungs to complete gas exchange and systemic blood perfusion in patients with severe cardiopulmonary insufficiency, which also plays an important role in the field of heart transplantation. Besides circulatory support treatment after heart transplantation, ECMO may also be used to prolong the waiting time for heart transplantation in patients with respiratory and circulatory failure before operation, as a bridging therapy for heart transplantation. However, at present, the application of ECMO in pediatric heart transplantation still exist challenges, such as high perioperative mortality and difficulty in determining the timing of treatment, etc. In this article, the development history of ECMO application in pediatric heart transplantation, use of ECMO before and after pediatric heart transplantation, ECMO-related complications in children, and application of ventricular assist device (VAD) in pediatric heart transplantation were briefly reviewed, aiming to provide reference for promoting the application of ECMO in pediatric heart transplantation.

Extracorporeal membrane oxygenation for adult patients with acute poisoning in China: a retrospective analysis of CSECLS registry from 2017 to 2021 / 中华急诊医学杂志

Objective:To analyze the status of extracorporeal membrane oxygenation (ECMO) for poisoned patients in China, and prognosis, complications and risk factors for death in poisoned patients supported with ECMO.Methods:The data of adult poisoned patients registered in Chinese Society of Extracorporeal Life Support (CSECLS) database were collected. Patients were divided into the survival group and death group according to the conditions at discharge. The type of poisoning, patient prognosis, hemodynamic parameters and complications before and after ECMO were retrospectively analyzed.Results:A total of 96 poisoned patients supported with ECMO were included in the database from 2017 to 2022, including 77 adult patients. The use of ECMO for poisoning was more common in Henan Province (28 cases, 36%), Guangdong Province (11 cases, 14%) and Zhejiang Province (9 cases, 8%). The number of adult poisoned patients registered in the database increased over time from 2017 to 2022, but the survival rate showed no significant difference ( P = 0.794). Agricultural poisoning was the most common indication (43%). Veno-arterial (V-A) ECMO was used in 60 patients (78%) and venovenous (V-V) ECMO in 27 patients (22%). Thirty-two patients (42%) survived to hospital discharge. The mean duration of ECMO support was 57 (34, 123) h, the mean duration of mechanical ventilation was 88 (33, 211) h, the mean length of hospital stay was 10 (2, 21) days, and the mean length of ICU stay was 9 (2, 18) days. Multivariate analysis showed that 24-h lactic acid level was significantly associated with mortality ( OR = 0.378, 95% CI: 0.183-0.779, P = 0.008). Conclusions:ECMO can be used as a salvage strategy to treat various types of severe poisoning. Although the application of ECMO is expanded rapidly in China, it is still necessary to optimize intervention indications and treatment timing, and adopt standardized ECMO management and monitoring strategies to improve the prognosis of patients.

Efficacy of Fluid Administration Followed by Lung Sonography in Hemodynamic Assessment in Acute Circulatory Failure in Critically Ill Patients

Background:Early recognition and appropriate treatment of shock have been shown to decrease mortality. Incorporation of bedside ultrasound in patients with undifferentiated shock allows for rapid evaluation ofreversible causes of shock and improves accurate diagnosis in undifferentiated hypotension. The aim of the present study was to evaluate efficacy of fluid administration followed by lung sonography in hemodynamic assessment in acute circulatory failure in critically ill patients.Materials and Methods: This prospective cohort controlled randomized study was carried out on 50 Critically ill Patients who had acute circulatory failure in intensive care unit Tanta university hospital Critically ill patients of either sex aged 21-60 years when mean blood pressure was below 65 mmHg were included. Patients have been uniformly distributed in2 categories, The patients assigned either to the Control Group (group I) or to the FALLS (fluid administration limited by lung sonography) protocol group (group II)Results:Comparison between two groups revealed that, the heart rate showed that heart rate is lower in group II in comparison to group I .Comparison between two groups revealed that, the mean arterial blood pressure changes showed that it is higher in group II in comparison to group I .Comparison between two groups revealed that, the Central venous pressure showed that no significant difference in the base line .Intensive care unit stay in group I rangedbetween 5 –11 days while in group II ranged between 3 –8 days .Survival analysis (Kaplan Mier curve), Mortality at 28 days found in group I mean 21.28 days with SE 1.898 and in group II mean 24 days with SE 1.64 with no significant difference in time but there was significant difference in number of mortalities as discussed before.Conclusion:We conclude from this study that bedside Lung Ultrasound has a good accuracy and superiority in assessment over other traditionally used methods for detecting early signs of pulmonary congestion and thus guides the fluid administration in shock management to decrease complications, mortality and intensive care stay

Pulmonary hypertension caused by amniotic fluid embolism / 中国实用妇科与产科杂志

Positive cardiopulmonary resuscitation is a guarantee for successful rescue.To remove pulmonary hypertension as soon as possible is the key to successful treatment.Dobutamine and milrinone have the effect of strengthening the heart and expanding the pulmonary artery,which is the drug of first choice for treatment.

Monitoring center venous pressure to guide the treatment of acute circulatory failure: give up or persist / 中国小儿急救医学

Central venous pressure (CVP) is one of the most commonly used parameters in hemodynamic monitoring, and monitoring CVP to guide the treatment of acute circulatory failure is a relatively common clinical method.However, many studies have pointed out that CVP is affected by many factors and has great limitations, which cannot provide help for the treatment of acute circulatory failure.This review summarized the analysis of the working principle of CVP, its value in treatment and influencing factors.The main purpose is to get a better understanding of CVP.

Monitoring center venous pressure to guide the treatment of acute circulatory failure:give up or persist / 中国小儿急救医学

Central venous pressure (CVP) is one of the most commonly used parameters in hemody-namic monitoring,and monitoring CVP to guide the treatment of acute circulatory failure is a relatively com-mon clinical method. However,many studies have pointed out that CVP is affected by many factors and has great limitations,which cannot provide help for the treatment of acute circulatory failure. This review summa-rized the analysis of the working principle of CVP,its value in treatment and influencing factors. The main purpose is to get a better understanding of CVP.

Diagnostic value of plasma procalcitonin for bacterial infection in patients receiving extracorporeal membrane oxygenation / 中华急诊医学杂志

Objective To evaluate the diagnostic value of plasma procalcitonin (PCT) for bacterial infection in patients receiving extracorporeal membrane oxygenation (ECMO). Methods Clinical data of patients receiving ECMO therapy admitted between August 2016 and January 2018 in Department of Critical Care Medicine, Tongji Hospital of Tongji Medical College were analyzed retrospectively. All patients receiving ECMO with bacterial culture were eligible for inclusion. Plasma PCT, IL-6, CRP and WBC levels detected within 24 h of bacterial cultures were analyzed immediately. Bacterial infection in ECMO was determined through bacterial culture and clinical characteristics. Finally, receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of inflammatory markers for bacterial infection in ECMO patients. Results Seventeen patients met the inclusion criteria, including 15 patients with acute respiratory failure and 2 patients with acute circulatory failure. There were 37 positive bacterial cultures, and 91 plasma PCT levels were detected in the process of ECMO. Compared with IL-6, CRP and WBC, plasma PCT had significant clinical significance in the diagnosis of bacterial infection (AUC=0.818, P<0.001). The cut-off value of PCT was 1.0 ng/mL, with a sensitivity of 92％ and a specificity of 43％. Conclusions Compared with other conventional inflammatory markers, plasma PCT has more diagnostic value for bacterial infection in ECMO patients.

The clinical experience of emergency medical team-initiated extracorporeal membrane oxygenation / 中华急诊医学杂志

Objective To summarize the efficacy of extracorporeal membrane oxygenation (ECMO)utilization in Emergency Department (ED),as well as the establishment of emergency ECMO team.Methods A retrospective analysis was carried out in 16 patients treated with ECMO between April 2015 to December 2016 in ED.The clinical data including demographics,diagnosis,initiating ECMO timing,place of ECMO establishment,intubation approaches,duration of ECMO,complications and outcomes were collected and analyzed.Results Eight patients were successfully weaned from ECMO,and 7 of them survived to discharge from hospital.The duration of ECMO support was 4 to 384 hours.The emergency ECMO team was set up.Conclusions Emergency medical team can successfully operate the ECMO process.The emergency medical team-initiated ECMO can provide effectively adjuvant measures to support patients with respiratory failure,circulatory failure and cardiac arrest.

La microcirculación en el paciente crítico: parte II: evaluación y microcirculación como objetivo terapéutico / Microcirculation in the critically ill patient: part II: evaluation and microcirculation as a therapeutic target

La sepsis grave y shock séptico involucran una compleja red de alteraciones circulatorias, inflamatorias y metabólicas que llevan finalmente a una disrupción energética celular. Las alteraciones microcirculatorias son frecuentes en el paciente séptico. Su observación directa mediante el uso de vídeomicroscopia como sides-tream dark field (SDF) ha permitido la construcción de falla microcirculatoria como concepto clínico en el paciente crítico. Diversas intervenciones terapéuticas empleadas rutinariamente en el tratamiento del paciente crítico parecen estar asociadas con cambios limitados en la perfusión de la microcirculación, con independencia de la hemodinamia sistémica, debido a la naturaleza heterogénea de estas alteraciones y los mecanismos potencialmente involucrados.

Severe sepsis and septic shock involve circulatory, inflammatory and metabolic disorders eventually resulting in a disruption of cellular energy. Microcirculatory disturbances are common in septic patients. Direct observation using sidestream dark field (SDF) videomicroscopy has enabled the construction of microcirculatory failure as a clinical concept in the critically ill patients. Many therapeutic interventions routinely used in the treatment of critically ill patients seem to be associated with limited changes in microcirculatory perfusion, irrespective of systemic hemodynamics, given the heterogeneous nature of these changes and the mechanisms potentially involved.

La microcirculación en el paciente crítico: parte I: generalidades y fisiología en el paciente séptico / Microcirculation in the critically ill. Part I: Review and physiology of septic patients

Severe sepsis and septic shock involve circulatory, inflammatory and metabolic disorders eventually resulting in a disruption of cellular energy. Microcirculatory disturbances are common in septic patients. Microcir-culation is the primary site of oxygen and nutrients exchange to cells. Direct observation using Sidestream Dark Field (SDF) imaging has allowed direct visualization of microcirculatory failure in critically ill patients. Septic shock is characterized by weak or vulnerable microcirculatory units and heterogeneity of microcircula-tory flow. Multiple mechanisms may contribute to these alterations, including endothelial dysfunction, altered glycocalyx, impaired inter-cell communication and adhesion and rolling of white blood cells and platelets. Many therapeutic interventions routinely used in the treatment of critically ill patients seem to result in limited changes in microcirculatory perfusion, irrespective of systemic hemodynamics, due to the heterogeneous nature of these changes and the potentially involved mechanisms. Therefore, microcirculatory alterations and their presence in states of shock, especially in septic shock, can represent diagnostic and severity stratification tools and may be a target for therapeutic intervention (microcirculatory resuscitation), besides suggesting a prognostic role.

La sepsis grave y shock séptico involucran una compleja red de alteraciones circulatorias, inflamatorias y metabólicas que llevan finalmente a una disrupción energética celular. Las alteraciones microcirculatorias son frecuentes en el paciente séptico. La microcirculación corresponde al sitio anatómico-funcional donde ocurre el intercambio de oxígeno y nutrientes hacia la célula. Su observación directa mediante el uso de videomicroscopía como sidestream dark field (SDF) ha permitido la construcción de falla microcirculatoria como concepto clínico en el paciente crítico. En el shock séptico la existencia de unidades microcirculatorias débiles y la heterogeneidad del flujo microcirculatorio son características. Múltiples mecanismos contribuyen a estas alteraciones, incluyendo la disfunción endotelial, daño del glicocálix, alteración en la comunicación intercelular, adhesión y rotación de leucocitos y plaquetas. Diversas intervenciones terapéuticas empleadas rutinariamente en el tratamiento del paciente crítico parecen estar asociadas con cambios limitados en la perfusión de la microcirculación, con independencia de la hemodinamia sistémica, debido a la naturaleza heterogénea de estas alteraciones y los mecanismos potencialmente involucrados. Así, las alteraciones microcirculatorias y su persistencia en estados de shock, especialmente shock séptico, se pueden mostrar como una herramienta diagnóstica y de estratificación de gravedad, pudiendo ser un objetivo de intervención terapéutica (resucitación microcirculatoria) presentando a su vez un rol pronóstico.

Significance for monitoring oxygen delivery and metabolism in circulatory failure situations / 中国小儿急救医学

Failure to deliver sufficient oxygen to the tissues and failure to utilize oxygen in the tissues are essential pathophysiological changes in circulatory failure situations.This is common in all kinds of shocks.Monitoring oxygen delivery and metabolism not only changes the ways to assess the shock but also affects the managements of shocks deeply.Monitoring and controlling global and tissue oxygen delivery and metabolism are goals for circulatory failure assessment and management in the future.

Common hemodynamic classification of circulatory failure and therapy principles / 中国小儿急救医学

According to the hemodynamic changes,circulatory failure is divided into warm shock and cold shock,and severe circulatory failure often co-exist in both conditions in children.Circulatory failure in children is characterized by rapid change on hemodynamic status,pathologic vasodilation,relative or absolute hypovolemia,myocardial depression,altered blood flow distribution,and metabolic disorders.Therapeutic strategies include improving cardiac output and tissue perfusion,achieving SVO2＞70％ and cardiac index to 3.3～6.0 L/( min· m2 ),ensuring the intravascular blood volume and cardiac load.

Progress of severe hand, food and mouth disease / 国际儿科学杂志

The virus of hand, foot and mouth disease(HFMD) damages nerve system.Brainstem is the main site and has some specific receptors.Severe HFMD has a high mortality.The main causes of death are cardiopulmonary and brain failure, so it is very important that risk factors of severe HFMD are timely judged and treated. Pulmonary edema of severe HFMD is mainly caused by neurological damage. At present, although it has still no standardized treatment scheme, the diagnosis and treatment for different stages have a significant effect.

Changes of vital signs in dog progressive cirulatory failures induced by soman / 中华急诊医学杂志

Objective To investigate the changes of vital signs and the damage of important organs in dog progressive circulatory failures induced by soman.Method Seven male dogs,weighing(12～15)kg,were injected intramuscularly 1/3 LD sornan(1 LD=10μg/kg)per ten minutes.The moan blood pressure decreased to (40～45)mmHg was defined as circulatory failure.The changes of heart rate,blood pressure.and hemodynamic parameters were evaluated by an eight-channel direct-witing oscillograph,blood gas,pH value,electrolyte,and the damage of important organs were observed before and after sornan injection.Statistical analysis of the data was performed using the self control t test with the SAS 6.12 Software Program.Results In anesthetized dogs intoxicated with sornan,the circulatory failure was characterized by the significant decreases in blood pressure,heart rate and hemodymrnic parameters(P<0.05).Partial pressure of oxygen was less than 60 mmHg,saturation of oxygen Was less than 90% and partial pressure of carbon dioxide was greater than 50 mmHg in arterial blood of the dog model.These results showed mix respiratory failure occurred during intermittent positive pressure.Significant metabolic acidosis was induced by soman[pH(7.345±0.064)vs.(6.956±0.022),P<0.01].The concentralion of sodium ion and chloride ion in blood were changed gently.The concentrations of GTP,GOT,Cr,BUN,CK-MB and LDH were increased significantly(P<0.05),which showed multiple important organs including liver,kidney and heart were damaged by sornan.Conclusions The severe progressive circulatory failure induced by cholinesterase inhibitor sornan leads to the darnage of vital signs and important organs significantly.

Changes of hemodynamic parameters and ECG in circulatory failure rats induced by organophosphate insecticides / 中国病理生理杂志

AIM: To investigate the changes of hemodynamic parameters and ECG in circulatory failure rats induced by organophosphate insecticides DDV and parathion.METHODS: Healthy Wistar male rats,weighing(320?20)g,were treated with organophosphate insecticides by ip.to induce circulatory failure.When the mean blood pressure(MBP) decreased to 45 mmHg,the changes of hemodynamic parameters and ECG were observed.RESULTS: In circulatory failure rats,SBP,DBP,MBP,HR,LVDP,IP,+dp/dtmax,-dp/dtmax,Vpm and +dp/dtmax/IP changed dramatically(P