Ações de cuidado e diagnósticos de enfermagem ao paciente com oxigenação por membrana extracorpórea: translação do conhecimento / Acciones de cuidado y diagnósticos de enfermería para pacientes con oxigenación por membrana extracorpórea: traslación del conocimiento / Care actions and nursing diagnoses for patients with extracorporeal membrane oxygenation: knowledge translation

Resumo Objetivo mapear diagnósticos e ações de enfermagem para o cuidado ao paciente adulto com oxigenação por membrana extracorpórea, considerando um protocolo e um sistema informatizado de prescrição e a inclusão de novas ações de cuidados, em um processo de translação do conhecimento à prática clínica. Métodos estudo descritivo e exploratório, com mapeamento cruzado entre um protocolo assistencial e sistema informatizado de um hospital universitário, no período de 2014 a 2018. Foram realizados dois encontros com a chefia de enfermagem e membros do time de oxigenação por membrana extracorpórea para validar as ações. Resultados diagnósticos mais comuns utilizados nos 45 prontuários dos pacientes com oxigenação por membrana extracorpórea foram: Risco de infecção (100%); Ventilação espontânea prejudicada (93,33%); Síndrome do déficit de autocuidado (93,33%). Conclusão e implicações para a prática o mapeamento incluiu 25 novas ações associadas a 14 diagnósticos de enfermagem no sistema informatizado, visando a disseminação do conhecimento e sua aplicação em cuidados reais a pacientes com oxigenação por membrana extracorpórea.

Resumen Objetivo mapear diagnósticos y acciones de enfermería para el cuidado de pacientes adultos con oxigenación por membrana extracorpórea, considerando un protocolo y un sistema de prescripción computarizado y la inclusión de nuevas acciones de cuidado, en un proceso de traslación del conocimiento a la práctica clínica. Métodos estudio descriptivo, exploratorio, con mapeo cruzado entre un protocolo de atención y un sistema informatizado en un hospital universitario, de 2014 a 2018. Posteriormente se realizaron dos reuniones con la gerente de enfermería y miembros del equipo de oxigenación por membrana extracorpórea para validar acciones. Resultados los diagnósticos más frecuentes utilizados en los 45 prontuarios de pacientes con oxigenación por membrana extracorpórea fueron: Riesgo de infección (100%); Deterioro de la ventilación espontánea (93,33%); Síndrome de déficit de autocuidado (93,33%). Conclusión e implicaciones para la práctica el mapeo incluyó 25 nuevas acciones asociadas a 14 diagnósticos de enfermería en el sistema informatizado, con el objetivo de difundir el conocimiento y su aplicación en la atención real al paciente con oxigenación por membrana extracorpórea.

Abstract Objective to map diagnoses and nursing actions for the care of adult patients with extracorporeal oxygenation membrane, considering a protocol and a computerized prescription system and the inclusion of new care actions, in a process of translating knowledge to clinical practice. Methods descriptive and exploratory study, with cross-mapping between a care protocol and a computerized system of at a university hospital, from 2014 to 2018. Two meetings were held with the nursing manager and members of the extracorporeal oxygenation membrane team to validate the actions. Results most common diagnoses used in the 45 medical records of patients with extracorporeal membrane oxygenation were: Risk of infection (100%); Impaired spontaneous ventilation (93.33%); Self-care deficit syndrome (93.33%). Conclusion and implications for practice The mapping included 25 new actions, associated with 14 nursing diagnoses in the computerized system, aiming to disseminate knowledge and its application in real care for patients with extracorporeal oxygenation membrane.

Atención de enfermería en preescolar con atresia pulmonar en oxigenación con membrana extracorpórea: caso exitoso / Nursing Care in Kindergarten with Pulmonary Atresia in Extracorporeal Membrane Oxygenation: a Succesful Case / Cuidados de enfermagem em uma criança pré-escolar com atresia pulmonar em oxigenação por membrana extracorpórea: caso de sucesso

Introducción. La atresia pulmonar con comunicación interventricular es una cardiopatía compleja que enmarca grandes desafíos en su etapa pre y postquirúrgica; el uso del soporte vital extracorpóreo con membrana de oxigenación restablece la oxigenación y perfusión al organismo para permitir recuperación y complementar estudios. El objetivo de este caso clínico es determinar la atención de enfermería en la fase aguda post quirúrgica. Se expondrá usando el modelo teórico de Dorothea Orem: teorías de déficit de autocuidado y teoría de sistemas. Esta cardiopatía es la forma más severa de la tetralogía de Fallot. Tiene una incidencia del 2% entre todas las cardiopatías. Metodología. Es el caso de una preescolar con atresia pulmonar con comunicación interventricular, se describe los procesos realizados desde el diagnóstico, la intervención percutánea y reparo quirúrgico, así como el manejo de lesión residual en el marco del uso de diferentes tecnologías. Se resalta como elemento clave el uso del soporte con oxigenación con membrana extracorpórea usada como puente a decisión. Resultados. El plan de atención de enfermería en esta fase crítica logró los resultados planteados como la adecuada perfusión y oxigenación, recuperación de la función ventricular, estabilización hemodinámica para ser llevada al reparo de la lesión residual. Este novedoso soporte fue implementado dos veces durante la misma hospitalización y con resultados exitosos. Conclusiones. Caso de difícil manejo con terapias convencionales, pero con aplicación de una atención integral de enfermería; el uso de tecnología y de diversas especialidades permitió un egreso de la menor sin complicaciones. Palabras clave: Atresia Pulmonar; Oxigenación por membrana extracorpórea; Atención de Enfermería; Unidades de Cuidado Intensivo Pediátrico; Cardiopatías Congénitas.

Introduction. The pulmonary atresia with ventricular septal defect is a complex heart disseas that possess great challenges in pre and post-surgical stages; the use of vital support extracorporeal with membrane oxygenation restores oxygen and perfusion to the body to allow recovery and complement studies. The objetive of this case report is to determinate the nurse attention in the acute post quirulgical phase. It will be presented using Dorothea Orem's theoretical model: theories of self-care deficits and systems theory. This heart disease is the most severe form of tetralogy Fallot. It has an incidence of 2% among all heart diseases. Methodology. This is the case of a kindergarten with pulmonary atresia with ventricular septal defect, the processes carried out from diagnosis, percutaneous intervention and surgical repair are described, as well as the management of residual injury within the framework of the use of different technologies. The use of extracorporeal membrane oxygenation support used as a decision bridge is highlighted as a key element. Results. The nursing care plan in the critical phase achieved the results proposed as adequate perfusion and oxygenation, recovery of the ventricular function, hemodynamic stabilization to be carried out to repair the residual injury. This newfangled support was implemented twice during the same hospitalization with sucessful result. Conclusions. Case report with struggle managment with conventional therapies but with the application of comprehensive nursing care; the use of technology and the work of various specialities allowed the minor to be discharged without complications. Keywords: Pulmonary Atresia; Extracorporeal Membrane Oxygenation; Nursing Care; Intensive Care Units, Pediatric; Heart Defects, Congenital.

Introdução. A atresia pulmonar com comunicação interventricular é uma cardiopatia complexa que apresenta grandes desafios em sua fase pré e pós-cirúrgica. O uso de suporte de vida extracorpóreo com membrana de oxigenação restaura a oxigenação e a perfusão do corpo para permitir a recuperação e complementar os estudos. O objetivo deste caso clínico é determinar os cuidados de enfermagem na fase aguda pós-cirúrgica. Será apresentado utilizando o modelo teórico de Dorothea Orem: teorias do déficit de autocuidado e teoria de sistemas. Esta doença cardíaca é a forma mais grave de tetralogia de Fallot. Tem uma incidência de 2% entre todas as doenças cardíacas. Metodologia. É o caso de uma criança em idade pré-escolar com atresia pulmonar com comunicação interventricular, são descritos os processos realizados desde o diagnóstico, intervenção percutânea e reparação cirúrgica, bem como o manejo da lesão residual no âmbito da utilização de diferentes tecnologias. Destaca-se, como elemento-chave, a utilização de suporte com oxigenação por membrana extracorpórea como ponte para a decisão. Resultados. O plano de cuidados de enfermagem nesta fase crítica alcançou os resultados propostos como perfusão e oxigenação adequadas, recuperação da função ventricular, estabilização hemodinâmica a ser realizada para o reparo da lesão residual. Este novo suporte foi implementado duas vezes durante a mesma hospitalização e com resultados bem-sucedidos. Conclusões. Caso de difícil manejo com terapias convencionais, mas com aplicação de cuidados integrais de enfermagem, o uso da tecnologia e de diversas especialidades permitiu que a criança recebesse alta sem complicações. Palavras-chave: Atresia Pulmonar; Oxigenação por Membrana Extracorpórea; Cuidados de Enfermagem; Unidades de Terapia Intensiva Pediátrica; Cardiopatias Congênitas.

Oxigenação por membrana extracorpórea conduzida por enfermeiros na pandemia por coronavírus em um centro especializado / Oxigenación por membrana extracorpórea realizada por enfermeras en la pandemia de coronavirus en centro especializado / Extracorporeal membrane oxygenation conducted by nurses in the coronavirus pandemic at a specialized center

Objetivo:analisar o impacto dos desafios na condução da oxigenação por membrana extracorpórea realizada pelo enfermeiro em paciente com infecção por coronavírus. Método: trata-se de um relato de caso com coleta de dados documental num Centro Especializado no Rio de Janeiro. O participante da pesquisa, possuía 30 anos, com diagnóstico de infecção por coronavírus foi submetido a oxigenação extracorpórea veno-venosa por 18 dias. Análise descritiva pautada na identificação dos desafios ao protocolo institucional do suporte circulatório e nas estratégias de enfrentamento com apoio das recomendações científicas vigentes. Resultados: os principais desafios foram restrição de mobilização, insuficiência de drenagem, distúrbios de coagulação e broncoscopia seriada. Conclusões: os impactos identificados nacondução do suporte foram a alta demanda para a enfermagem elevando o tempo e o quantitativo de profissionais necessários para a assistência segura com melhoria dos cuidados de enfermagem relacionados a mobilização e arevisão do protocolo de anticoagulação.

Objective: to analyze the impact of challenges in conducting extracorporeal membrane oxygenation performed by nurses in patients with coronavirus infection. Method: this is a case report with documentary data collection in a Specialized Center in Rio de Janeiro. The research participant was 30 years old, with a diagnosis of coronavirus infection was underwent veno-venous extracorporeal oxygenation for 18 days. Descriptive analysis based on the identification of challenges to the institutional protocol of circulatorysupport and coping strategies supported by current scientific recommendations. Results: the main challenges were restriction of mobilization, insufficiency of drainage, coagulation disorders and serial bronchoscopy. Conclusions: the impacts identified in the conduct of support were the high demand for nursing, increasing the time and number of professionals needed for safe care with improvement of nursing care related to mobilization and review of the anticoagulation protocol.

Objetivo: analizar el impacto de los desafíos en la realización de la oxigenación por membrana extracorpórea realizada por enfermeras en pacientes con infección por coronavirus. Método: es un informe de caso con recolección de datos documentales en un Centro Especializado en Río de Janeiro. El participantede la investigación tenía 30 años,con infección por coronavirus,se le realizó oxigenación extracorpórea veno-venosa durante 18 días. Análisis descriptivo basado en la identificación de desafíos al protocolo institucional de apoyo circulatorio y estrategias de afrontamiento sustentadas en recomendaciones científicas actuales. Resultados:los principales desafíos fueron: restricción de la movilización, insuficiencia de drenaje, trastornos de la coagulación y broncoscopia seriada. Conclusiones: los impactos identificados en la conducta de apoyo fueron: alta demanda de enfermería, aumentando el tiempo y número de profesionales necesarios para un cuidado seguro con mejora de los cuidados de enfermería relacionados con la movilización y revisión del protocolo de anticoagulación.

Pharmacokinetics and pharmacodynamics of antibiotics in septic children treated with extracorporeal membrane oxygenation / 中华儿科杂志

Objective: To investigate the characteristics of pharmacokinetic (PK) and pharmacodynamic (PD) parameters of antibacterial agents in children with sepsis treated by extracorporeal membrane oxygenation (ECMO). Methods: In this prospective cohort study, 20 children with sepsis (confirmed or suspected) who were treated with ECMO and antimicrobial in the Department of Critical Medicine of Hunan Children's Hospital from March 2021 to December 2022 were enrolled as the ECMO group. Through therapeutic drug monitoring (TDM), the PK-PD parameters of antibacterial agents were analyzed. Twenty five children with sepsis in the same department who were treated with vancomycin but no ECMO at the same time were enrolled as the control group. The individual PK parameters of vancomycin were calculated by Bayesian feedback method. The PK parameters in the two groups were compared, and the correlation between trough concentration and area under the curve (AUC) was analyzed. Wilcoxon rank sum test was used for inter group comparison. Results: Twenty patients in the ECMO group, included 6 males and 14 females, with an onset age of 47 (9, 76) months. In the ECMO group, 12 children (60%) were treated with vancomycin, and the trough concentration was less than 10 mg/L in 7 cases, 10-20 mg/L in 3 cases, and >20 mg/L in 2 cases; AUC/minimum inhibitory concentration (MIC) (MIC=1 mg/L)<400 was in 1 case, 400-600 in 3 cases, and >600 in 8 cases. Among the 11 children (55%) who were treated with β-lactam antibiotics, there were 10 cases with drug concentration at 50% dosing interval (CT50)>4 MIC and 9 cases with trough concentration>MIC, both CT50 and trough concentration of cefoperazone reached the target. Among the 25 cases of control group, 16 were males and 9 females, with an onset age of 12 (8, 32) months. There was a positive correlation between vancomycin trough concentration and AUC (r2=0.36, P<0.001). The half-life of vancomycin and the 24-hour AUC (AUC0-24 h) in the ECMO group were higher than those in the control group (5.3 (3.6, 6.8) vs. 1.9 (1.5, 2.9) h, and 685 (505, 1 227) vs. 261 (210, 355) mg·h/L, Z=2.99, 3.50, respectively; both P<0.05), and the elimination rate constant and clearance rate was lower than those in the control group (0.1 (0.1, 0.2) vs. 0.4 (0.2, 0.5), 0.7 (0.5, 1.3) vs. 2.0 (1.1, 2.8) L/h, Z=2.99, 2.11, respectively; both P<0.05). Conclusion: The PK-PD parameters in septic children treated by ECMO varied with a longer half-life, higher AUC0-24 h, lower elimination rate constant and clearance rate.

Recent research on extracorporeal carbon dioxide removal / 中国当代儿科杂志

Extracorporeal carbon dioxide removal is an artificial lung auxiliary technique based on extrapulmonary gas exchange and can effectively remove carbon dioxide and provide oxygenation to a certain extent, and it is one of the effective treatment techniques for hypercapnia developed after mechanical ventilation and extracorporeal membrane oxygenation in recent years and has wide application prospect. This article elaborates on the development, working principle, advantages, classification, complications, and clinical application of extracorporeal carbon dioxide removal, so as to provide a new choice for extracorporeal carbon dioxide removal in clinical practice.

Pulse pressure loss after extracorporeal cardiopulmonary resuscitation is an independent predictor of ECMO weaning failure / 中华危重病急救医学

OBJECTIVE@#To analyze the predictors of successful weaning off extracorporeal membrane oxygenation (ECMO) after extracorporeal cardiopulmonary resuscitation (ECPR).@*METHODS@#The clinical data of 56 patients with cardiac arrest who underwent ECPR in Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University) from July 2018 to September 2022 were retrospectively analyzed. According to whether ECMO was successfully weaning off, patients were divided into the successful weaning off group and the failed weaning off group. The basic data, duration of conventional cardiopulmonary resuscitation (CCPR, the time from cardiopulmonary resuscitation to ECMO), duration of ECMO, pulse pressure loss, complications, and the use of distal perfusion tube and intra-aortic balloon pump (IABP) were compared between the two groups. Univariate and multivariate Logistic regression analyses were performed to identify the risk factors for weaning failure of ECMO.@*RESULTS@#Twenty-three patients (41.07%) were successfully weaned from ECMO. Compared with the successful weaning off group, patients in the failed weaning off group were older (years old: 46.7±15.6 vs. 37.8±16.8, P < 0.05), higher incidence of pulse pressure loss and ECMO complications [81.8% (27/33) vs. 21.7% (5/23), 84.8% (28/33) vs. 39.1% (9/23), both P < 0.01], and longer CCPR time (minutes: 72.3±19.5 vs. 54.4±24.6, P < 0.01), shorter duration of ECMO support (hours: 87.3±81.1 vs. 147.7±50.8, P < 0.01), and worse improvement in arterial blood pH and lactic acid (Lac) levels after ECPR support [pH: 7.1±0.1 vs. 7.3±0.1, Lac (mmol/L): 12.6±2.4 vs. 8.9±2.1, both P < 0.01]. There were no significant differences in the utilization rate of distal perfusion tube and IABP between the two groups. Univariate Logistic regression analysis showed that the factors affecting the weaning off ECMO of ECPR patients were pulse pressure loss, ECMO complications, arterial blood pH and Lac after installation [pulse pressure loss: odds ratio (OR) = 3.37, 95% confidence interval (95%CI) was 1.39-8.17, P = 0.007; ECMO complications: OR = 2.88, 95%CI was 1.11-7.45, P = 0.030; pH after installation: OR = 0.01, 95%CI was 0.00-0.16, P = 0.002; Lac after installation: OR = 1.21, 95%CI was 1.06-1.37, P = 0.003]. After adjusting for the effects of age, gender, ECMO complications, arterial blood pH and Lac after installation, and CCPR time, showed that pulse pressure loss was an independent predictor of weaning failure in ECPR patients (OR = 1.27, 95%CI was 1.01-1.61, P = 0.049).@*CONCLUSIONS@#Early loss of pulse pressure after ECPR is an independent predictor of failed weaning off ECMO in ECPR patients. Strengthening hemodynamic monitoring and management after ECPR is very important for the successful weaning off ECMO in ECPR.

Factors associated with acute kidney injury in patients undergoing extracorporeal membrane oxygenation: retrospective cohort / Factores asociados a la lesión renal aguda en pacientes sometidos a oxigenación por membrana extracorpórea: cohorte retrospectiva / Fatores associados a lesão renal aguda em pacientes submetidos à oxigenação por membrana extracorpórea: coorte retrospectivo

ABSTRACT Objective: To identify factors associated with acute kidney injury in patients undergoing extracorporeal membrane oxygenation. Method: Retrospective cohort study conducted in an adult Intensive Care Unit with patients undergoing extracorporeal membrane oxygenation from 2012 to 2021. The research used the Kidney Disease Improving Global Outcomes as criteria for definition and classification of acute kidney injury. A multiple logistic regression model was developed to analyze the associated factors. Results: The sample was composed of 122 individuals, of these, 98 developed acute kidney injury (80.3%). In multiple regression, the associated factors found were vasopressin use, Nursing Activities Score, and glomerular filtration rate. Conclusion: The use of vasopressin, the Nursing Activities Score, and the glomerular filtration rate were considered as factors related to the development of acute kidney injury in patients undergoing extracorporeal membrane oxygenation.

RESUMEN Objetivo: Identificar los factores asociados a la lesión renal aguda en pacientes sometidos a oxigenación por membrana extracorpórea. Material y método: Estudio de cohortes retrospectivo realizado en una unidad de cuidados intensivos de adultos con pacientes sometidos a oxigenación por membrana extracorpórea entre 2012 y 2021. El criterio de definición y clasificación de lesión renal aguda fue el Kidney Disease Improving Global Outcomes. Se desarrolló un modelo de regresión logística múltiple para el análisis de los factores asociados. Resultados: La muestra estuvo compuesta por 122 individuos, de estos, 98 desarrollaron lesión renal aguda (80,3%). En la regresión múltiple, los factores asociados encontrados fueron el uso de vasopresina, el Nursing Activities Score y la tasa de filtración glomerular. Conclusión: El uso de vasopresina, el Nursing Activities Score y la tasa de filtración glomerular se consideraron factores relacionados con el desarrollo de lesión renal aguda en pacientes sometidos a oxigenación por membrana extracorpórea.

RESUMO Objetivo: Identificar os fatores associados à lesão renal aguda em pacientes submetidos a oxigenação por membrana extracorpórea. Método: Estudo de coorte retrospectivo, realizado em uma Unidade de Terapia Intensiva adulta, com pacientes submetidos à oxigenação por membrana extracorpórea, no período de 2012 a 2021. O critério para definição e classificação da lesão renal aguda foi o da Kidney Disease Improving Global Outcomes. Para a análise dos fatores associados foi elaborado um modelo de regressão logística múltipla. Resultados: A amostra foi composta por 122 indivíduos, destes, 98 desenvolveram lesão renal aguda (80,3%). Na regressão múltipla, os fatores associados encontrados foram a utilização de vasopressina, o Nursing Activities Score e a taxa de filtração glomerular. Conclusão: O uso da vasopressina, o Nursing Activities Score e a taxa de filtração glomerular foram considerados como fatores relacionados ao desenvolvimento de lesão renal aguda em paciente submetido à oxigenação por membrana extracorpórea.

Costo-efectividad de la oxigenación con membrana extracorpórea en pacientes con síndrome de dificultad respiratoria aguda en Colombia / Cost-effectiveness of extracorporeal membrane oxygenation in patients with acute respiratory distress syndrome in Colombia

Introducción. La terapia con oxigenación con membrana extracorpórea es costosa y, aunque existe existen indicios en la literatura de que puede ser una intervención costo-efectiva en los países desarrollados, hay dudas sobre su costo-efectividad en un país con un producto interno bruto per cápita bajo, como Colombia. Objetivo. Determinar el incremento de la relación costo-efectividad de la terapia con oxigenación con membrana extracorpórea en pacientes con síndrome de dificultad respiratoria aguda en Colombia. Materiales y métodos. Se eligieron pacientes adultos con diagnóstico de síndrome de dificultad respiratoria aguda para el análisis de costo-efectividad desde la perspectiva del sistema de salud. Se compararon aquellos pacientes con asistencia respiratoria mecánica con volúmenes bajos con aquellos tratados con oxigenación con membrana extracorpórea. Se determinaron los costos médicos directos de la atención y el incremento de la relación costo-efectividad a los 6 meses. Resultados. El costo esperado por paciente en asistencia respiratoria mecánica protectora fue de COP$ 17'609.909. El costo del soporte mediante terapia de oxigenación con membrana extracorpórea fue de COP$ 98'784.116. La relación de costo-efectividad promedio fue de COP$ 141'662.435 por cada vida salvada (USD$ 41.276). Conclusiones. El soporte con terapia de oxigenación con membrana extracorpórea tuvo un costo promedio de COP$ 141'662.435 por cada vida salvada, equivalente a USD$ 41.276 dólares y el incremento de la relación costo-efectividad fue de COP$ 608'783.750 (USD$ 177.384), casi diez veces superior a la regla de decisión de 3 PBI per cápita (COP$ 59'710.479).

Introduction: Extracorporeal membrane oxygenation therapy is expensive. There is evidence in the literature that it can be a cost-effective intervention in developed countries; however, in countries with low gross domestic product per capita, such as Colombia, there are still some doubts. Objective: To determine the incremental cost-effectiveness ratio of extracorporeal membrane oxygenation in patients with acute respiratory distress syndrome in Colombia. Materials and methods: Cost-effectiveness analysis in healthcare in relation to adult patients diagnosed with acute respiratory distress syndrome with mechanical ventilation with low volumes compared to extracorporeal membrane oxygenation. The direct medical costs and the incremental cost-effectiveness ratio were determined at 6 months. Results: The expected cost per patient on protective mechanical ventilation was COP$ 17,609,909. The cost of extracorporeal membrane oxygenation therapy support in surviving patients was COP$ 98,784,116. The average cost-effectiveness ratio of extracorporeal membrane oxygenation was COP$ 141,662,435 for each life saved (USD$ 41,276). Conclusions: Support with extracorporeal membrane oxygenation therapy had an average cost of COP$ 141,662,435 for each life saved equivalent to USD$ 41,276. The incremental cost-effectiveness ratio COP$ was 608,783,750 (USD$ 177,384); almost ten times higher than the decision rule of three gross domestic product per capita (COP$ 59,710,479).

ECMO venovenoso durante procedimiento endoscópico de permeabilización de la vía aérea central en pacientes con riesgo vital: reporte de 2 casos / Use of venovenous extracorporeal membrane oxygenation (ECMO) during endoscopic treatment of central airway obstruction and vital risk: report of 2 cases

Resumen: La oxigenación por membrana extracorpórea (ECMO) es de gran utilidad al proveer soporte ventilatorio a pacientes con hipoxia, pero su utilidad en el manejo de pacientes con obstrucción central de la vía aérea y riesgo vital no ha sido frecuentemente usada. La broncoscopía intervencional como terapia bajo ventilación convencional es de alto riesgo en este tipo de pacientes, pero es posible lograr excelentes resultados al ser asociada a ECMO. Comunicamos el caso clínico de 2 pacientes que presentaban disnea en reposo y falla ven1ila1oria aguda ca1as1rófica debido a una obstrucción casi total del lumen traqueal, de causa tumoral. En ambos pacientes en forma urgente se inició soporte circulatorio mediante ECMO VV, mientras se efectuaba la resección tumoral broncoscópica. Luego de terminada la cirugía traqueal, en ambos pacientes se retiró el soporte, siendo decanulados sin eventos y con una buena evolución clínica posterior. Se discute el beneficio del soporte ECMO en este tipo de pacientes.

Abstract: In patients with severe central airway stenosis bronchoscopy-guided intervention therapy under conventional ventilation conveys a high risk. Extracorporeal membrane oxygenation (ECMO) provides very good cardiopulmonary support, but is rarely used in bronchoscopy-guided interventional therapy. We report 2 patients with resting dyspnea due to severe tumor tracheal obstruction and acute pulmonary failure with imminent vital risk. Both patients were cannulated and the ECMO circuit installed on a nearly emergency basis. Tumors were excised, and the patients weaned from cardiopulmonary bypass uneventfully. Subsequent clinical course was satisfactory in both cases. A brief discussion of this condition is included.

Implementación de membrana de oxigenación extracorpórea. Relato de experiencia / Implementation of extracorporeal oxygenation membrane. Experience report

Se incorporó en la institución un recurso que se utiliza hace algunos años en la Argentina, pero con la pandemia tomó vital importancia; se trata de la Membrana de Oxigenación Extracorpórea, (ECMO). Es una modalidad de apoyo vital de alta complejidad y costo, que se utiliza en pacientes con insuficiencia respiratoria o cardiaca severas. ECMO consiste en un circuito de circulación extracorpórea que permite la eliminación del dióxido de carbono y la oxigenación de la sangre. Hay dos tipos de circuitos: el veno-arterial, en el cual el circuito toma la sangre venosa de las cavas, y el atrio derecho, se oxigena y luego se la regresa al circuito mayor a través de la aorta, y el circuito veno-venoso, que toma la sangre venosa de la vena cava inferior y la regresa oxigenada al atrio derecho. La implementación del ECMO en el Sanatorio Allende, exigió cambios importantes de manera estructurada e integrada con un plan multidisciplinario dirigido al cuidado de los pacientes. Donde el enfoque de la enfermera hacia la persona en una situación crítica sometida a ECMO se considera determinante, siendo este profesional esencial para el proceso. El equipo de salud es responsable de una presencia continua para monitorear, vigilar y prevenir complicaciones, así como del manejo y coordinación de la atención. Se desarrolló el protocolo de cuidado, haciendo hincapié en las fortalezas, debilidades y oportunidades. La importancia de este nuevo desafío en el servicio de Unidad Coronaria radica en adquirir nuevos conocimientos, tecnologías, unificar cuidados de enfermería en post del bienestar, la recuperación y la seguridad del paciente[AU]

A resource that has been used for some years in Argentina was incorporated into the institution, but with the pandemic it took on vital importance; This is ECMO (extracorporeal membrane oxygenation). It is a life support modality of high complexity and cost, which is used in patients with severe respiratory or heart failure. ECMO consists of an extracorporeal circulation circuit that allows the elimination of carbon dioxide and oxygenation of the blood. There are two types of circuits: the veno-arterial, in which the circuit takes venous blood from the cavas and the right atrium, oxygenates it and then returns it to the larger circuit through the aorta, and the veno-arterial circuit. venous, which takes venous blood from the inferior vena cava and returns it oxygenated to the right atrium. The implementation of ECMO at the Sanatorio Allende requires important changes in a structured and integrated manner with a multidisciplinary plan aimed at patient care. Where the nurse's approach to the person in a critical situation subjected to ECMO is considered decisive, this professional being essential for the process. The health team is responsible for a continuous presence to monitor, monitor and prevent complications, as well as the management and coordination of care. The protocol was developed, emphasizing the strengths, weaknesses and The importance of this new challenge in the Coronary Unit service lies in acquiring new knowledge, technologies, unifying nursing care in post-wellness, recovery and patient safety[AU]

Um recurso usado há alguns anos na Argentina foi incorporado à instituição, mas com a pandemia assumiu vital importância; Isso é ECMO (oxigenação por membrana extracorpórea). É uma modalidade de suporte de vida de alta complexidade e custo, que é utilizada em pacientes com insuficiência respiratória ou cardíaca grave. A ECMO consiste em um circuito de circulação extracorpórea que permite a eliminação do dióxido de carbono e a oxigenação do sangue. Existem dois tipos de circuitos: o veno-arterial, no qual o circuito leva o sangue venoso das cavas e do átrio direito, oxigena-o e depois o devolve ao circuito maior através da aorta, e o circuito veno-arterial. que retira o sangue venoso da veia cava inferior e o devolve oxigenado ao átrio direito. A implantação da ECMO no Sanatório Allende requer mudanças importantes de forma estruturada e integrada com um plano multidisciplinar voltado para a assistência ao paciente. Onde a abordagem do enfermeiro à pessoa em situação crítica submetida à ECMO é considerada decisiva, sendo este profissional essencial ao processo. A equipe de saúde é responsável por uma presença contínua para monitorar, monitorar e prevenir complicações, bem como a gestão e coordenação do cuidado. O protocolo foi desenvolvido, enfatizando os pontos fortes, fracos e A importância deste novo desafio no serviço da Unidade Coronariana está em adquirir novos conhecimentos, tecnologias, unificar os cuidados de enfermagem no pós-bem, recuperação e segurança do paciente[AU]

Dispositivos de asistencia ventricular en el shock cardiogénico posinfarto: importancia del soporte hemodinámico: reporte de caso / Ventricular assist devices in post-infarction cardiogenic shock: importance of hemodynamic support: case report / Dispositivos de assistência ventricular no choque cardiogênico pós-infarto: importância do suporte hemodinâmico: relato de caso

El shock cardiogénico posinfarto caracterizado por un estado de insuficiencia circulatoria sistémica requiere de un tratamiento precoz en vistas a restablecer la estabilidad hemodinámica y la función ventricular. Este consta de la reperfusión coronaria mediante revascularización miocárdica; en algunos casos es necesaria la utilización de dispositivos de asistencia ventricular. El ECMO venoarterial es un sistema de circulación extracorpórea que permite un soporte biventricular oxigenando la sangre y reintroduciéndola mediante un flujo continuo hacia la circulación arterial sistémica. El uso de dicho dispositivo en pacientes con shock cardiogénico ha mostrado una mejoría significativa de la sobrevida a 30 días en comparación con el uso del balón de contrapulsación intraaórtico. No obstante, sus potenciales complicaciones, como dificultad en el vaciamiento ventricular izquierdo, síndrome de Arlequín, sangrados e infecciones, hacen fundamental la formación y el trabajo en equipo del heart team. Un porcentaje no menor de estos pacientes presentarán una severa disfunción ventricular permanente, por lo que podrían ser candidatos a dispositivos de asistencia ventricular izquierda de larga duración tipo Heartmate III como puente al trasplante cardíaco, el cual ha mostrado resultados satisfactorios con una excelente sobrevida a mediano plazo.

Post-infarction cardiogenic shock characterized by a state of systemic circulatory failure requires early treatment in order to restore hemodynamic stability and ventricular function. This consists of coronary reperfusion through myocardial revascularization, requiring in some cases the use of ventricular assist devices. Veno-arterial ECMO is an extracorporeal circulation system that allows biventricular support by oxygenating the blood and reintroducing it through a continuous flow towards the systemic arterial circulation. The use of this device in patients with cardiogenic shock has shown a significant improvement in survival at 30 days compared to the use of intra-aortic balloon pump. However, its potential complications, such as difficulty in left ventricular emptying, Harlequin syndrome, bleeding and infections, make the training and teamwork of the heart team essential. A great percentage of these patients will present a severe permanent ventricular dysfunction, so they could be candidates for long-term mechanical circulatory support devices like Heartmate III as a bridge to transplant or myocardial recovery, or destination therapy, which has shown satisfactory results with excellent medium-term survival.

O choque cardiogênico pós-infarto caracterizado por um estado de insuficiência circulatória sistêmica requer tratamento precoce para restabelecer a estabilidade hemodinâmica e a função ventricular. Esta consiste na reperfusão coronariana por meio de revascularização miocárdica, necessitando, em alguns casos, do uso de dispositivos de assistência ventricular. A ECMO venoarterial é um sistema de circulação extracorpórea que permite o suporte biventricular oxigenando o sangue e reintroduzindo-o através de um fluxo contínuo para a circulação arterial sistêmica. O uso desse dispositivo em pacientes com choque cardiogênico mostrou melhora significativa na sobrevida em 30 dias em relação ao uso de contrapulsação com balão intra-aórtico. No entanto, suas potenciais complicações, como dificuldade de esvaziamento ventricular esquerdo, síndrome de Harlequin, sangramentos e infecções, tornam imprescindível o treinamento e o trabalho em equipe do time do coração. Não uma pequena porcentagem desses pacientes apresentará uma condição ventricular permanente grave, podendo ser candidatos a dispositivos de assistência ventricular esquerda de longa duração do tipo Heartmate III como ponte para o transplante cardíaco, que tem demonstrado resultados satisfatórios com excelente sobrevida em médio prazo.

Membrana de circulación extracorpórea veno-arterial para ablación de tormenta eléctrica en shock cardiogénico: caso clínico / Veno-arterial extracorporeal membrane oxygenation (ECMO) used for support during ablation of ventricular electrical storm: case report

RESUMEN: Se presenta el caso clínico de un paciente que presenta un infarto del miocardio con trombolisis no exitosa y posterior implantación de 2 stents coronarios quien desarrolla, algunos días después, una tormenta eléctrica ventricular. Una ablación de la taquicardia se realizó bajo ECMO, con buen resultado. Se detalla la descripción del caso, revisa y discute el tema.

ABSTRAC: A patient with a myocardial infarction whom, following a failed thrombolisis and implantion of 2 stents developed a ventricular electrical storm and hemodynamic instability. A successful ablation of the tachycardia with the use of ECMO was performed. A full description is included, along with a discussion of the subject.

Clinical analysis of 6 critically ill children with acute chlorine poisoning / 中华儿科杂志

Objective: To analyze the clinical characteristics and treatment of critically ill children with acute chlorine poisoning and explore the risk factors and effective strategies. Methods: This retrospective study collected the clinical data, including general state, clinical characteristics, treatment and follow-up(till 1 year and 6 months after discharge), of 6 critically ill children who were hospitalized in the Pediatric Intensive Care Unit of Beijing Children's Hospital due to acute chlorine poisoning in August 2019. Results: There were 6 children characterized by severe dyspnea in this accident, among whom 4 were boys and two girls, aged 4-12 years. When the accident occurred, they were within 5 m of the chlorine source. These patients underwent tracheal intubation and mechanical ventilation in 3.5-7.0 h after poisoning. The child who was the closest to the chlorine source (1.5 m) and took the longest time (5 min) to evacuate was the most severe one. He suffered hypoxia which could not be corrected by conventional mechanical ventilation and severe shock, then had veno-arterial extracorporeal membrane oxygenation(ECMO) treatment started 10 h after the accident. All the 6 children in this study survived. Following-up found no growth and developmental abnormality. The pulmonary function tests were normal except for one case with increased small airway resistance due to previous suspected asthma, and the lung CT, electhoencephalogram, and brain magnetic resonance imaging were all normal. Conclusions: Severe chlorine poisoning is mainly characterized by respiratory failure. Mechanical ventilation is often required within a few hours after poisoning. When conventional mechanical ventilation is ineffective, ECMO could save live. Timely treatment could improve prognosis.

Ultrasound-guided percutaneous cannulation for extracorporeal membrane oxygenation in children / 中华儿科杂志

Objective: To evaluate the effectiveness and safety of ultrasound-guided percutaneous cannulation for extracorporeal membrane oxygenation (ECMO) in children. Methods: In this retrospective observational study, 66 cases who underwent non-cardiac surgery ECMO in pediatric intensive care unit (PICU) of Shanghai Children's Hospital from May 2016 to April 2021 were collected. The demographics, model of ECMO support, type and size of arteriovenous cannulas, way of catheterization and complications were recorded and summarized. Patients were divided into percutaneous cannulation group and surgical cannulation group according to catheterization strategies. The demographics, duration of cannulation and ECMO support, ECMO weaning rate and hospital survival rate were compared among two groups. χ2 and nonparametric rank sum test were used for comparison. Results: Among the 66 patients who received ECMO, 38 were male and 28 were female, with age 44.5 (12.0, 83.5) months and weight 15.0 (10.0, 25.0) kg; 21 patients underwent percutaneous cannulation, with a success rate of 95% (20 cases). Point-of-care ultrasound was performed for all percutaneous cannulation cases. The duration of percutaneous cannulation was significantly shorter than that of surgical cannulation (26.0 (23.3, 30.3) vs. 57.0 (53.8, 64.0) min, Z=6.31, P<0.001). Successful percutaneous cannulation cases were aged 70.5 (23.8, 109.5) months, and their weight was 23.2 (13.6, 37.0) kg. Ten cases were initially given veno-venous (VV) ECMO support, and 10 cases were given veno-arterial (VA) ECMO support. ECMO arterial cannulas were sized from 8 F to 17 F, and venous cannulas sized from 10 F to 19 F. For VV-ECMO, the right internal jugular and femoral veins were used as vascular access, while VA-ECMO used right internal jugular vein-femoral artery or right femoral vein-left femoral artery approach. Only one patient suffered severe complication (superior vena cava perforation). There was no catheter-related bloodstream infection. Conclusion: Ultrasound-guided percutaneous cannulation for ECMO can be performed with a high rate of success and safety in children.

Early effect of extracorporeal membrane oxygenation and factors related to early outcome in adult patients with fulminant myocarditis / 中华心血管病杂志

Objective: To evaluate the efficacy within the first 24 h post extracorporeal membrane pulmonary oxygenation (ECMO) and the impact of early efficacy on the prognosis of adult patients with fulminant myocarditis (FM). Methods: This retrospective case analysis study included hospitalized patients (age≥18 years) who were diagnosed with fulminant myocarditis from November 2016 to May 2021 in the First Affiliated Hospital of Zhengzhou University. Patients were divided into survival or non-survival groups according to treatment outcomes. The age, sex, treatments, drug use, ECMO use, clinical and laboratory data (before and 24 h after the use of ECMO) were analyzed. The change rate of clinical and laboratory data after 24 h use of ECMO was calculated to find differences between two groups. Multivariate logistic regression was used to analyze the related factors with in-hospital death and complication between the two groups. Results: A total of 38 FM patients treated with ECMO were included. There were 23 cases (60.5%) in the survival group, aged (39.6±13.7) years, and 17 (73.9%) cases were female. The total ECMO time was (134.4±71.3)h. There were 15 cases (39.5%) in non-survival group, aged (40.0±15.8) years, and there were 12(80.0%) female, the ECMO time was (120.1±72.4) h in this group. The proportion of tracheal intubation and continuous renal replacement therapy in the survivor group and dosage of norepinephrine within 24 h after ECMO implantation were significantly less than in non-survival group (all P<0.05). There was no significant difference in all efficacy related biochemical indexes between two groups before ECMO use. The levels of lactic acid, procalcitonin, creatinine, alanine aminotransferase, aspartate aminotransferase, creatine kinase-MB, cardiac troponin I and N-terminal B-type natriuretic peptide prosoma were significantly less in survival group than in non-survival group at 24 h after the use of ECMO (all P<0.05). Results of multivariate logistic regression analysis showed that the higher 24 h change rate of creatinine (OR=0.587, 95%CI 0.349-0.986, P=0.044) and creatine kinase-MB (OR=0.177, 95%CI 0.037-0.841, P=0.029) were positively correlated with reduced risk of in-hospital mortality. The central hemorrhage and acute kidney injury in survival group were less than in non-survivor group (P<0.05). Conclusions: After 24 h early use of ECMO in FM patients, the improvement of various efficacy related biochemical test indexes in the survival group was better than that in the non-survival group. Faster reduction of creatine kinase-MB and creatinine values within 24 h ECMO use is positively correlated with reduced risk of in-hospital mortality in adult patients with FM.

Risk factors for venoarterial-extracorporeal membrane oxygenation related nosocomial infection in children after cardiac surgery / 中南大学学报(医学版)

OBJECTIVES@#Extracorporeal membrane oxygenation (ECMO) is an extracorporeal life support strategy for the treatment of critically ill children with reversible heart and lung failure, increasingly being used in patients with low cardiac output after cardiac surgery. However, the mortality of patients is closely related to the complications of ECMO, especially bleeding, thrombosis, and infection, ECMO-related nosocomial infection has become a challenge to the success of ECMO. This study aims to analyze the incidence and risk factors for venoarterial-ECMO (VA-ECMO)-related nosocomial infections in children after cardiac surgery.@*METHODS@#We retrospectively collected the data of patients who underwent VA-ECMO treatment after pediatric cardiac surgery in the Second Xiangya Hospital of Central South University from July 2015 to March 2021, and divided them into an infected group and a non-infected group. The clinical characteristics of the 2 groups of patients, VA-ECMO-related nosocomial infection factors, pathogenic microorganisms, and patient mortality were compared. Logistic regression was used to analyze the risk factors for nosocomial infection related to VA-ECMO after cardiac surgery.@*RESULTS@#Of the 38 pediatric patients, 18 patients (47.37%) had VA-ECMO related nosocomial infection, served as the infected group, including 7 patients with blood infections and 11 respiratory tract infections. Gram-negative pathogens (16 strains, 88.9%) were the main bacteria, such as Acinetobacter baumannii (6 strains), Klebsiella pneumoniae (3 strains), and Stenotrophomonas maltophilia (3 strains). Compared with the non-infected group (n=20), the infection group had longer time of cardiopulmonary bypass, time of myocardial block, and time of VA-ECMO assistance (All P<0.05). Multivariate logistic regression analysis showed that time of cardiopulmonary bypass (OR=1.012, 95% CI 1.002 to 1.022; P=0.021) was an independent risk factor for ECMO-related nosocomial infection. The number of surviving discharges in the infected group was less than that in the non-infected group (1 vs 11, P<0.05).@*CONCLUSIONS@#Cardiopulmonary bypass time is an independent risk factor for VA-ECMO-related nosocomial infection in children after cardiac surgery. Shortening the duration of extracorporeal circulation may reduce the incidence of VA-EMCO-related nosocomial infections in children after cardic surgery. The occurrence of VA-ECMO-related nosocomial infections affects the number of patient's discharge alive.

Application of extracorporeal membrane oxygenation in the treatment of persistent pulmonary hypertension of the newborn / 中国当代儿科杂志

OBJECTIVES@#To study the clinical value of extracorporeal membrane oxygenation (ECMO) in the treatment of persistent pulmonary hypertension of the newborn (PPHN).@*METHODS@#A retrospective analysis was performed on the medical data of 11 neonates with PPHN who were treated with ECMO in the Neonatal Intensive Care Unit of Zhongshan People's Hospital from January 2015 to December 2021, involving the neonates' general information, clinical diagnosis, laboratory results, duration of ECMO treatment, complications during ECMO treatment, length of hospital stay, and outcome.@*RESULTS@#Of the 11 neonates, 10 (91%) had successful weaning from ECMO, and 8 (73%) survived. For the 11 neonates, the mean duration of ECMO treatment was (81±50) hours (range: 26 to 185 hours), the mean duration of ventilator use was (198±105) hours (range: 57 to 392 hours), and the mean length of hospital stay was (22±15) days (range: 2 to 49 days). The oxygenation index and blood lactate level were significantly improved after 24 hours of ECMO treatment among the 11 neonates (P<0.05). Ten neonates had significantly reduced pulmonary artery pressure after 24 hours of ECMO treatment (P<0.05). One neonate had a progressive increase in the pulmonary artery pressure during EMCO treatment, succumbing to death. This neonate was diagnosed with alveolar capillary dysplasia based on the histopathological findings of the lung tissue and whole-exome sequencing results. Among the 11 children, 5 had intracranial hemorrhage, 1 had disseminated intravascular coagulation, 1 had gastric hemorrhage, 2 had pulmonary hemorrhage, 1 had renal insufficiency, and 3 had bleeding at the puncture site during ECMO treatment.@*CONCLUSIONS@#ECMO is effective for the treatment of PPHN, however, the high incidence of complications of ECMO treatment suggests that it is important to carefully assess the indications and timing of ECMO treatment and improve the management of ECMO, which can improve the weaning rate and survival rate.

Aeromedical interhospital transport of an adult with COVID-19 on extracorporeal membrane oxygenation: case report / Transporte aeromédico inter hospitalario de adulto con COVID-19 en oxigenación por membrana extra corpórea: reporte de caso / Transporte inter-hospitalar aeromédico de adulto com COVID-19 em oxigenação por membrana extracorpórea: relato de caso

Abstract Objective: To describe the experience of aeromedical interhospital transport of an adult patient with severe hypoxemic respiratory failure due to SARS-CoV-2, on extracorporeal membrane oxygenation. Method: This is a case report, guided by the tool Case Report Guidelines, with a descriptive approach. Data were collected from the digital medical record and field notes after the approval by the Institution and the Human Research Ethics Committee. Results: The transport of a critically ill, unstable patient with acute respiratory syndrome 2 on extracorporeal oxygenation was an opportunity for the team to acquire new knowledge. The proper preparation of the fixed-wing aircraft and the profile of the team of specialist nurses contributed to the safety and quality in the three phases of flight: preflight, in-flight and post-flight. Conclusion: Air transport of adults on cardiopulmonary bypass to referral centers, under the care of an experienced multidisciplinary team, can contribute to positive results. The nurses' autonomy, their leadership role and expertise in process management are highlighted. Thus, success was evidenced with the patient's discharge after 45 days from the Intensive Care Unit.

RESUMEN Objetivo: Describir la experiencia del transporte inter hospitalario aeromédico de un paciente adulto, con hipoxia grave por SARS-CoV-2, en uso de membrana de oxigenación extra corpórea. Método: Reporte de caso, guiado por la herramienta Case Report Guidelines, con abordaje descriptivo. Los datos fueron recolectados del historial clínico digital del paciente y de los apuntes de campo tras aprobación hecha por la Institución y por el Comité de Ética e Investigación con Seres Humanos. Resultados: El transporte del paciente en estado grave, instable, con síndrome respiratoria aguda 2 en uso de oxigenación extra corpórea fue una oportunidad para el equipo asimilar nuevos conocimientos. La preparación adecuada de la aeronave de ala fija y el perfil del equipo de enfermeros expertos contribuyeron para realizar con seguridad y calidad las tres etapas del vuelo: antes, durante y después del vuelo. Conclusión: El transporte aéreo de adultos a los centros de referencia en circulación extra corpórea, bajo los cuidados de un equipo con diversos profesionales experientes, puede ser contributivo para los resultados positivos. Se pone de relieve la autonomía de los enfermeros, el rol de liderazgo y la expertise en el manejo de procesos. Para tal, el éxito fue evidenciado por el alta al paciente después de 45 días en Unidad de Cuidados Intensivos.

RESUMO Objetivo: Descrever a experiência do transporte inter-hospitalar aeromédico de um paciente adulto, com insuficiência respiratória hipoxêmica grave por SARS-CoV-2, em uso de membrana de oxigenação extracorpórea. Método: Relato de caso, norteado pela ferramenta Case Report Guidelines, com abordagem descritiva. Os dados foram coletados do prontuário digital e do diário de campo após aprovação feita pela Instituição e pelo Comitê de Ética e Pesquisa com Seres Humanos. Resultados: O transporte do paciente em estado crítico, instável, com síndrome respiratória aguda 2 em uso de oxigenação extracorpórea foi uma oportunidade para a equipe assimilar novos conhecimentos. O preparo adequado da aeronave de asa fixa e o perfil da equipe de enfermeiros especialistas contribuíram para realizar com segurança e qualidade as três fases de voo: pré-voo, durante o voo e pós voo. Conclusão: O transporte aéreo de adultos para os centros de referência em circulação extracorpórea, sob os cuidados de uma equipe multiprofissional experiente, pode contribuir para os resultados positivos. Destaca-se a autonomia dos enfermeiros, o papel de liderança e a expertise no gerenciamento de processos. Para tal, o sucesso foi evidenciado pela alta do paciente após 45 dias do Centro de Terapia Intensiva.