Extracorporeal Cardiopulmonary Resuscitation for an Out-of-Hospital Cardiac Arrest

Extra corporeal membrane oxygenation (ECMO) for refractory out?of?hospital cardiac arrest (OHCA) has been shown to improve outcome in many Western countries. There are no reports of ECMO being used to support OHCA in India till date. We report a case of a young man who developed cardiac arrest (CA) while driving and was given bystander cardiac massage. He was brought to tertiary care center where an ECMO was utilized for refractory CA. The patient subsequently underwent emergency coronary artery stenting and was weaned off ECMO and ventilation. We discuss the case and highlight the role of bystander cardiopulmonary resuscitation.

Venovenous extra-corporeal membrane oxygenation for severe acute respiratory distress syndrome: a matched cohort study / 中华医学杂志(英文版)

Background@#Although the use of extra-corporeal membrane oxygenation (ECMO) has been rapidly increasing, the benefit of ECMO in patients with acute respiratory distress syndrome (ARDS) remains unclear. Our objective was to investigate the effect of venovenous ECMO (VV-ECMO) on adult patients with severe ARDS.@*Methods@#We conducted a multi-center, retrospective, cohort study in the intensive care units (ICUs) of six teaching hospitals between January 2013 and December 2018. Patients with severe ARDS who received VV-ECMO support were included. The detailed demographic data and physiologic data were used to match ARDS patients without ECMO. The primary endpoint was the 28-day mortality.@*Results@#Ninety-nine patients with severe ARDS supported by VV-ECMO and 72 patients without ECMO were included in this study. The acute physiology and chronic health evaluation II score was 23.1 ± 6.3 in the ECMO group and 24.8 ± 8.5 in the control group (P = 0.1195). The sequential organ failure assessment score was 12.8 ± 3.4 in the ECMO group and 13.7 ± 3.5 in the control group (P = 0.0848). The 28-day mortality of patients with ECMO support was 39.4%, and that of the control group was 55.6%. The survival analysis curve showed that the 28-day mortality in the ECMO group was significantly lower than that in the control group (P = 0.0097). Multivariate Cox regression analysis showed that the independent predictors of the 28-day mortality were the requirement of vasopressors before ECMO (hazard ratio [HR]: 1.006; 95% confidence interval [CI]: 1.001–1.013; P = 0.030) and duration of mechanical ventilation before ECMO (HR: 3.299; 95% CI: 1.264–8.609; P = 0.034).@*Conclusions@#This study showed that ECMO improved the survival of patients with severe ARDS. The duration of mechanical ventilation and the requirement of vasopressors before ECMO might be associated with an increased risk of death.

Extra-corporeal membrane oxygenation during the beating heart coronary artery bypass grafting for ;high risk patients-a single center experience / 中国介入心脏病学杂志

Objective To summarize clinical application, method and result of extra-corporeal membrane oxygenation ( ECMO) used during beating heart coronary artery bypass grafting ( CABG) in high risk patients. Methods Twenty one patients [ mean age ( 75. 7 ± 3. 6 ) years old ] who received beating-heart CABG surgery assisted with ECMO were included in the study. We observed the condition when ECMO weaned off, the duration on mechanical rentilato time of ICU stay and the occurance of related complications. Results Among the 21 patients, ECMO was weaned off uneventfully after surgery in 8 patients. Immediate weaning was failed in another 8 patients and required gradual weaning in 2. 0-4. 5 hrs. Five patients could not wean off the ECMO in operation room needing continuous ECMO support in CCU. ECMO was weaned off in CCU gradually with IABP support [mean IABP support time: (115. 0 ± 25. 9) hrs]. Among the 5 patients admitted into CCU, 1 patient had oozing from insertion site at femoral artery/rein region and was stopped with compressive bandage. Lower limb ischemia happened in another 1 patient and was recovered after set up of by-pass circulation. All 21 patients recovered well and smoothly. Mean in-hospital stay was (17. 4 ± 2. 8) d. Conclusions ECMO is a safe and effective circulatory support during beating heart coronary artery bypass surgery for high-risk patients with severe coronary artery disease in reducing the mortality and complications.

Recent advances in the management of congenital diaphragmatic hernia.

The management of congenital diaphragmatic hernia (CDH) is undergoing continual change and refinement, fuelled by recent advances in this field. Although many studies have documented the benefits of these recent advances but definite recommendations are lacking. Also, injudicious use of some of these strategies may be counterproductive, underscoring the importance of evidence based treatment strategy. This article discusses the utility of the recent advances in the management of CDH.

Bilateral lung transplantation for idiopathic pulmonary artery hypertension / 中华器官移植杂志

Objective To evaluate the operative technique, perioperative management and outcomes of bilateral lung transplantation for idiopathic pulmonary artery hypertension. Methods There were 2 cases of idiopathic pulmonary hypertension subject to bilateral sequential lung transplantation with ECMO support (16, 17 years old, respectively). The pulmonary artery pressure was 10/70 and 148/72 mm Hg respectively. The heart function was NYHA Ⅳ, the operative procedure was right lung first, then left lung, and the cold ischemia time was 230 min/430 min and 185 min/300 min respectively. The ECMO support time was 550 min and 450 min respectively. The blood loss during the operation was 3000 and 1200 ml, respectively. Resuits The ECMO was withdrawn 16 and 13 h postoperation respectively. There was unstable hemadynamics and acute left heart failure on the 3rd and 4th day after the operation. The patients were treated with ventilate support and tracheotomy on 3rd and 6th day respectively. Additionally, the patients were given cardiotonic, dieresis and the ventilation was withdrawn on 33rd and 12th day after the operation respectively. They were discharged from the hospital on 93rd and 32nd day after the operation. The heart function both reached NYHA I, two cases were followed up for 25 and 10 months respectively.Both of them had an excellent quality life. Conclusion Bilateral lung transplantation is effective for end-stage idiopathic pulmonary artery hypertension even with slight right ventricular dysfunction with satisfactory short-term outcome. A limited operative time, an ECMO support for heart and lung during the peri-operative period and a perfect management for the left ventricular dysfunction after surgery are key roles for the success. Closed follow-up and surveillance are needed for long-term outcomes.

Analysis of the associated complication with circulatory support device / 中华急诊医学杂志

Objetctive To summarize the associated complications with circulatory support device,and provide reference for chnical practice.Method A total of 8306 consecutive patients who underwent open heart surgery,in Department of Post-operation Intensive Care Unit of the Cardiac Surgery,Anzhen Hospital,Capital Medical University,was retrospectively studied from January 2005 to February 2007.And the clinical data of 246 patients including 63 female and 183 male patients with mean age 56.7±14.2 years supported with various circulatory support devices for perioperative cardiorespiratory function failure in ICU were analyzed.Left ventricular assist device (LVAD) was used in 3 patients by the cannulation of the left alritan and ascending aorta.The extracorporeal membrane oxygenation(ECMO) was established in 48 patients for postoperative cardiorespiratory function failure.The vencarterial bypass was established by cannulation of the right atrium in 41 patients and femoral artery and of venovenons in 2 patients,and of the right atrium and ascending aorta in 5 cases,lntra-aortic balloon pumping(I-ABP)was performed via the femoral artery either percutaneonsly by the Seldinger technique in 195 patients.The cardiac operations included coronary artery bypass grafting (n=170),coronary artery bypass grafting with romoldingof left ventricle (n = 22),coronary artery bypass grafting with valvular operation (n=10),valvular operation (n=27),heart transplantation(n=8),correction of congenital heart defects(n=6),aortic operations(n=2).The duration of circulatory support ranged from 4 to 451 hours.Correlative complications of 3 kinds of circulatory support device were compared and repair of ventricular septal perforation in the wake of acute myocardial infarction (n=1).Results Seventy-eight (31.7%) patients died.Seventy-one(28.9% ) patients devdoped various complications including infection(n=27),renal failure required renal rephcement therapy (n=27),re-exploration for bleeding(n=24),haemolysis(n=6),limb ischemia(n=15),neurological complications(n=6),oxygenator failure(n=7) Conchusions The improvement of management to reduce complications may result in improved outcomes of patients supported with circulatory support devices.