ABSTRACT
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.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Extracorporeal Membrane Oxygenation/nursing , Evidence-Based Nursing , Standardized Nursing TerminologyABSTRACT
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.
Subject(s)
Extracorporeal Membrane Oxygenation , Intensive Care Units, Pediatric , Pulmonary Atresia , Heart Defects, Congenital , Nursing CareABSTRACT
Objetivos: comparar o conteúdo dos registros de enfermagem referente à oxigenação por membrana extracorpórea (ECMO) entre os períodos de pré e pós-treinamento da equipe multidisciplinar. Método: estudo retrospectivo realizado em uma unidade de terapia intensiva adulto, com pacientes em uso de ECMO entre 2012 e 2019. Foram analisadas as informações das anotações, evoluções e prescrições de enfermagem sobre a ECMO. Resultados: foram incluídos 194 registros de enfermagem, que evidenciaram melhora na qualidade da evolução de enfermagem referente às informações da ECMO no período pós-treinamento. Dentre as informações, destaca-se a qualidade do registro sobre o circuito e a membrana. Conclusão: o treinamento multidisciplinar em ECMO foi fundamental para a melhoria das informações nas evoluções de enfermagem. Contudo, a continuidade de treinamentos se faz essencial para manutenção adequada dos registros de enfermagem que envolvem este suporte
Objectives: to compare nursing records regarding extracorporeal membrane oxygenation (ECMO) between pre- and post-multidisciplinary training. Method:A retrospective study was conducted in an Intensive Care Unit (ICU) with patients using ECMO, between 2012 and 2019. Notes, evolutions and nursing prescriptions on ECMO were analyzed. Results: the 194 nursing records analyzed revealed an improvement in the quality of nursing records regarding ECMO information post-training. Among the information, the quality of circuit and membrane records stands out. Conclusion: multidisciplinary training in ECMO was fundamental for improving information in nursing evolutions. However, continued training is essential for the proper maintenance of nursing records regarding this suppor
Objetivos: comparar el contenido de los registros de enfermería con respecto a la oxigenación por membrana extracorpórea (ECMO) entre los períodos pre y pos-entrenamiento del equipo multidisciplinario. Método: estudio retrospectivo, realizado en una unidad de cuidados intensivos (UCI), con pacientes en uso de ECMO entre 2012 y 2019. Se analizó información de notas, evoluciones y prescripciones de enfermería sobre ECMO. Resultados: se incluyeron 194 registros de enfermería, en los cuales se observó una mejora de la calidad en las evoluciones de enfermería respecto a la información de la ECMO en el período posterior al entrenamiento. Entre las informaciones destaca la calidad del registro en circuito y la membrana tras el entrenamiento. Conclusión: el entrenamiento multidisciplinar en ECMO fue fundamental para mejorar la información en los registros de enfermería. Sin embargo, la continuidad del entrenamiento es clave para el correcto mantenimiento de los registros de enfermería en relación con este apoyo
Subject(s)
Humans , Male , Female , Adult , Extracorporeal Membrane Oxygenation , Nursing Records , Nursing , Intensive Care UnitsABSTRACT
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.
Subject(s)
Extracorporeal Membrane Oxygenation , Nursing , Coronavirus Infections , Critical Care , COVID-19ABSTRACT
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.
Subject(s)
Humans , Carbon Dioxide , Extracorporeal Membrane Oxygenation , Renal Dialysis , Respiration, ArtificialABSTRACT
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.
Subject(s)
Female , Male , Humans , Child , Child, Preschool , Infant , Anti-Bacterial Agents/therapeutic use , Vancomycin/therapeutic use , Bayes Theorem , Extracorporeal Membrane Oxygenation , Prospective Studies , Sepsis/drug therapyABSTRACT
OBJECTIVE@#To evaluate and summarize the relevant evidence of anticoagulation and bleeding risk management in patients with extracorporeal membrane oxygenation (ECMO), and provide the evidence-based basis for the management of anticoagulation and bleeding during ECMO treatment.@*METHODS@#According to the evidence "6S" pyramid model, all evidence on ECMO anticoagulation management and bleeding risk was searched in relevant databases, organizations and guideline websites at home and abroad. Evidence types included guidelines, expert consensus, systematic evaluation, Meta-analysis and original study. The search time limit was from May 31, 2012 to May 31, 2022. Two researchers with evidence-based research background conducted independent literature quality evaluation of the retrieved evidence, and the evidence that met the quality standards was extracted and summarized based on the opinions of industry experts.@*RESULTS@#A total of 315 articles were retrieved, and 13 articles were included, including 3 guidelines, 6 expert consensus, and 4 Meta-analysis. A total of 27 best evidences were summarized from 7 aspects, including the selection of ECMO anticoagulation, anticoagulation in priming, anticoagulation in operation, anticoagulation monitoring, bleeding and treatment, thrombosis and treatment, and prevention and management of terminal limb ischemia.@*CONCLUSIONS@#This study provides evidence-based basis for bleeding prevention and anticoagulant management in ECMO patients. It is recommended to selectively apply the best evidence after evaluating the clinical environmental conditions of medical institutions, so as to improve the prognosis of ECMO patients.
Subject(s)
Humans , Extracorporeal Membrane Oxygenation/adverse effects , Blood Coagulation , Hemorrhage/etiology , Anticoagulants/adverse effects , Thrombosis/prevention & control , Retrospective StudiesABSTRACT
OBJECTIVE@#To explore the diagnosis and treatment of acute cerebral infarction following extracorporeal membrane oxygenation (ECMO) therapy in patients with cardiogenic shock to review the literature.@*METHODS@#The clinical data of two patients with cardiogenic shock treated with veno-arterial ECMO (VA-ECMO) complicated with acute cerebral infarction admitted to department of intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University were retrospectively analyzed and the treatment experience was shared.@*RESULTS@#Case 1 was a 46-year-old male patient who was admitted to the hospital on September 16, 2021, due to "repeated chest tightness, shortness of breath, syncope for 2+ years, and worsened for 15 days. Coronary artery angiography showed 3-vessel coronary artery disease lesions. On October 15, 2021, coronary artery bypass grafting (CABG), pericardial fenestration and drainage, thoracic closed drainage, femoral bypass, thoracotomy exploration, and sternal internal fixation were performed under support of extracorporeal circulation. After surgery, the heart rate was 180-200 bpm, the blood pressure could not be maintained, and the improvement was not obvious after active drug treatment. The right femoral artery and femoral vein were intubated, VA-ECMO support treatment was performed, and the patient was transferred to the ICU. Intra-aortic balloon pump (IABP) was treated on the day of transfer because the circulation could not be maintained. Due to acute cerebral infarction in the left hemisphere and right parieto-occipital lobe, subfalcine herniation, tentorial herniation, the patient ultimately died after withdrawing from ECMO. Case 2 was a 43-year-old male patient who was admitted to the hospital on June 29, 2021, with "fever for 8 days and vomiting for 4 days". Bedside ultrasound showed cardiac enlargement and diffuse wall motion reduction in the left and right ventricles. On June 30, 2021, the patient underwent catheterization through the right femoral artery and femoral vein, VA-ECMO support, and was transferred to ICU for treatment. Acute cerebral infarction on both sides of the cerebellum occurred, and after treatment, the patient was discharged with mild impairment of daily living ability.@*CONCLUSIONS@#Strengthen monitoring of anticoagulation; regular neurological examination of patients undergoing ECMO therapy; ECMO under light sedation or awake can be performed if the condition permitsif the condition permits, perform light sedation or awake ECMO, which helpful for the early detection of nervous system injury.
Subject(s)
Male , Humans , Middle Aged , Adult , Shock, Cardiogenic/therapy , Extracorporeal Membrane Oxygenation , Retrospective Studies , Coronary Artery Bypass/adverse effects , Cerebral Infarction/therapyABSTRACT
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.
Subject(s)
Humans , Extracorporeal Membrane Oxygenation , Blood Pressure , Retrospective Studies , Perfusion , Cardiopulmonary ResuscitationABSTRACT
Objective: To investigate the impact of combined use and timing of arterial-venous extracorporeal membrane oxygenation (VA-ECMO) with intra-aortic balloon pump (IABP) on the prognosis of patients with acute myocardial infarction complicated with cardiogenic shock (AMICS). Methods: This was a prospective cohort study, patients with acute myocardial infarction and cardiogenic shock who received VA-ECMO support from the Heart Center of Lanzhou University First Hospital from March 2019 to March 2022 in the registration database of the Chinese Society for Extracorporeal Life Support were enrolled. According to combination with IABP and time point, patients were divided into VA-ECMO alone group, VA-ECMO+IABP concurrent group and VA-ECMO+IABP non-concurrent group. Data from 3 groups of patients were collected, including the demographic characteristics, risk factors, ECG and echocardiographic examination results, critical illness characteristics, coronary intervention results, VA-ECMO related parameters and complications were compared among the three groups. The primary clinical endpoint was all-cause death, and the safety indicators of mechanical circulatory support included a decrease in hemoglobin greater than 50 g/L, gastrointestinal bleeding, bacteremia, lower extremity ischemia, lower extremity thrombosis, acute kidney injury, pulmonary edema and stroke. Kaplan-Meier survival curves were used to analyze the survival outcomes of patients within 30 days of follow-up. Using VA-ECMO+IABP concurrent group as reference, multivariate Cox regression model was used to evaluate the effect of the combination of VA-ECMO+IABP at different time points on the prognosis of AMICS patients within 30 days. Results: The study included 68 AMICS patients who were supported by VA-ECMO, average age was (59.8±10.8) years, there were 12 female patients (17.6%), 19 cases were in VA-ECMO alone group, 34 cases in VA-ECMO+IABP concurrent group and 15 cases in VA-ECMO+IABP non-concurrent group. The success rate of ECMO weaning in the VA-ECMO+IABP concurrent group was significantly higher than that in the VA-ECMO alone group and the VA-ECMO+IABP non-concurrent group (all P<0.05). Compared with the ECMO+IABP non-concurrent group, the other two groups had shorter ECMO support time, lower rates of acute kidney injury complications (all P<0.05), and lower rates of pulmonary edema complications in the ECMO alone group (P<0.05). In-hospital survival rate was significantly higher in the VA-ECMO+IABP concurrent group (28 patients (82.4%)) than in the VA-ECMO alone group (9 patients) and VA-ECMO+IABP non-concurrent group (7 patients) (all P<0.05). The survival rate up to 30 days of follow-up was also significantly higher surviving patients within were in the ECMO+IABP concurrent group (26 cases) than in VA-ECMO alone group (9 patients) and VA-ECMO+IABP non-concurrent group (4 patients) (all P<0.05). Multivariate Cox regression analysis showed that compared with the concurrent use of VA-ECMO+IABP, the use of VA-ECMO alone and non-concurrent use of VA-ECMO+IABP were associated with increased 30-day mortality in AMICS patients (HR=2.801, P=0.036; HR=2.985, P=0.033, respectively). Conclusions: When VA-ECMO is indicated for AMICS patients, combined use with IABP at the same time can improve the ECMO weaning rate, in-hospital survival and survival at 30 days post discharge, and which does not increase additional complications.
Subject(s)
Humans , Female , Middle Aged , Aged , Shock, Cardiogenic/complications , Extracorporeal Membrane Oxygenation/methods , Pulmonary Edema/complications , Aftercare , Prospective Studies , Patient Discharge , Myocardial Infarction/therapy , Intra-Aortic Balloon Pumping/methods , Treatment Outcome , Retrospective StudiesABSTRACT
Objective: To investigate the feasibility and safety of extracorporeal membrane oxygenation (ECMO)-supported percutaneous coronary intervention (PCI) in chronic coronary total occlusion (CTO) patients with reduced left ventricular ejection fraction (LVEF). Methods: The CTO patients with LVEF≤35% and undergoing CTO-PCI assisted by ECMO in the General Hospital of Northern Theater Command from December 2018 to March 2022 were enrolled in this study. The post-procedure complications, changes of LVEF from pre-procedure to post-procedure during hospitalization, and the incidence of all-cause mortality and changes of LVEF after discharge were assessed. Results: A total of 17 patients aged (59.4±11.8) years were included. There were 14 males. The pre-procedure LVEF of these patients were (29.00±4.08)%. Coronary angiography results showed that there were 29 CTO lesions in these 17 patients. There was 1 in left main coronary artery, 7 in left anterior descending artery, 11 in left circumflex artery, and 10 in right coronary artery. ECMO was implanted in all patients before procedure. Among 25 CTO lesions attempted to cross, 24 CTO were successfully implanted with stents. All patients underwent successful PCI for at least one CTO lesion. The number of drug-eluting stents implantation per patient were 4.6±1.3. After procedure, there were 8 patients with hemoglobin decreased>20 g/L, and 1 patient with ECMO-access-site related bleeding. The LVEF value at a median duration of 2.5 (2.0-5.5) days after procedure significantly increased to (38.73±7.01)% (P<0.001 vs. baseline). There were no in-hospital deaths. Patients were followed up for 360 (120, 394) days after discharge, 3 patients died (3/17). The LVEF value was (41.80±7.32)% at 155 (100, 308) days after discharge, which was significantly higher than the baseline value (P<0.001). Conclusion: The results of present study demonstrate that it is feasible, efficient and safe to perform ECMO)-supported CTO-PCI in CTO patients with reduced LVEF.
Subject(s)
Male , Humans , Stroke Volume , Ventricular Function, Left , Extracorporeal Membrane Oxygenation , Percutaneous Coronary Intervention , Heart , Vascular DiseasesABSTRACT
Objective: To investigate the impact of combined use and timing of arterial-venous extracorporeal membrane oxygenation (VA-ECMO) with intra-aortic balloon pump (IABP) on the prognosis of patients with acute myocardial infarction complicated with cardiogenic shock (AMICS). Methods: This was a prospective cohort study, patients with acute myocardial infarction and cardiogenic shock who received VA-ECMO support from the Heart Center of Lanzhou University First Hospital from March 2019 to March 2022 in the registration database of the Chinese Society for Extracorporeal Life Support were enrolled. According to combination with IABP and time point, patients were divided into VA-ECMO alone group, VA-ECMO+IABP concurrent group and VA-ECMO+IABP non-concurrent group. Data from 3 groups of patients were collected, including the demographic characteristics, risk factors, ECG and echocardiographic examination results, critical illness characteristics, coronary intervention results, VA-ECMO related parameters and complications were compared among the three groups. The primary clinical endpoint was all-cause death, and the safety indicators of mechanical circulatory support included a decrease in hemoglobin greater than 50 g/L, gastrointestinal bleeding, bacteremia, lower extremity ischemia, lower extremity thrombosis, acute kidney injury, pulmonary edema and stroke. Kaplan-Meier survival curves were used to analyze the survival outcomes of patients within 30 days of follow-up. Using VA-ECMO+IABP concurrent group as reference, multivariate Cox regression model was used to evaluate the effect of the combination of VA-ECMO+IABP at different time points on the prognosis of AMICS patients within 30 days. Results: The study included 68 AMICS patients who were supported by VA-ECMO, average age was (59.8±10.8) years, there were 12 female patients (17.6%), 19 cases were in VA-ECMO alone group, 34 cases in VA-ECMO+IABP concurrent group and 15 cases in VA-ECMO+IABP non-concurrent group. The success rate of ECMO weaning in the VA-ECMO+IABP concurrent group was significantly higher than that in the VA-ECMO alone group and the VA-ECMO+IABP non-concurrent group (all P<0.05). Compared with the ECMO+IABP non-concurrent group, the other two groups had shorter ECMO support time, lower rates of acute kidney injury complications (all P<0.05), and lower rates of pulmonary edema complications in the ECMO alone group (P<0.05). In-hospital survival rate was significantly higher in the VA-ECMO+IABP concurrent group (28 patients (82.4%)) than in the VA-ECMO alone group (9 patients) and VA-ECMO+IABP non-concurrent group (7 patients) (all P<0.05). The survival rate up to 30 days of follow-up was also significantly higher surviving patients within were in the ECMO+IABP concurrent group (26 cases) than in VA-ECMO alone group (9 patients) and VA-ECMO+IABP non-concurrent group (4 patients) (all P<0.05). Multivariate Cox regression analysis showed that compared with the concurrent use of VA-ECMO+IABP, the use of VA-ECMO alone and non-concurrent use of VA-ECMO+IABP were associated with increased 30-day mortality in AMICS patients (HR=2.801, P=0.036; HR=2.985, P=0.033, respectively). Conclusions: When VA-ECMO is indicated for AMICS patients, combined use with IABP at the same time can improve the ECMO weaning rate, in-hospital survival and survival at 30 days post discharge, and which does not increase additional complications.
Subject(s)
Humans , Female , Middle Aged , Aged , Shock, Cardiogenic/complications , Extracorporeal Membrane Oxygenation/methods , Pulmonary Edema/complications , Aftercare , Prospective Studies , Patient Discharge , Myocardial Infarction/therapy , Intra-Aortic Balloon Pumping/methods , Treatment Outcome , Retrospective StudiesABSTRACT
Objective: To investigate the feasibility and safety of extracorporeal membrane oxygenation (ECMO)-supported percutaneous coronary intervention (PCI) in chronic coronary total occlusion (CTO) patients with reduced left ventricular ejection fraction (LVEF). Methods: The CTO patients with LVEF≤35% and undergoing CTO-PCI assisted by ECMO in the General Hospital of Northern Theater Command from December 2018 to March 2022 were enrolled in this study. The post-procedure complications, changes of LVEF from pre-procedure to post-procedure during hospitalization, and the incidence of all-cause mortality and changes of LVEF after discharge were assessed. Results: A total of 17 patients aged (59.4±11.8) years were included. There were 14 males. The pre-procedure LVEF of these patients were (29.00±4.08)%. Coronary angiography results showed that there were 29 CTO lesions in these 17 patients. There was 1 in left main coronary artery, 7 in left anterior descending artery, 11 in left circumflex artery, and 10 in right coronary artery. ECMO was implanted in all patients before procedure. Among 25 CTO lesions attempted to cross, 24 CTO were successfully implanted with stents. All patients underwent successful PCI for at least one CTO lesion. The number of drug-eluting stents implantation per patient were 4.6±1.3. After procedure, there were 8 patients with hemoglobin decreased>20 g/L, and 1 patient with ECMO-access-site related bleeding. The LVEF value at a median duration of 2.5 (2.0-5.5) days after procedure significantly increased to (38.73±7.01)% (P<0.001 vs. baseline). There were no in-hospital deaths. Patients were followed up for 360 (120, 394) days after discharge, 3 patients died (3/17). The LVEF value was (41.80±7.32)% at 155 (100, 308) days after discharge, which was significantly higher than the baseline value (P<0.001). Conclusion: The results of present study demonstrate that it is feasible, efficient and safe to perform ECMO)-supported CTO-PCI in CTO patients with reduced LVEF.
Subject(s)
Male , Humans , Stroke Volume , Ventricular Function, Left , Extracorporeal Membrane Oxygenation , Percutaneous Coronary Intervention , Heart , Vascular DiseasesABSTRACT
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.
Subject(s)
Extracorporeal Membrane Oxygenation , Acute Kidney Injury , Nursing , Intensive Care UnitsABSTRACT
Introducción: Las cardiopatías congénitas son causa frecuente de insuficiencia cardíaca mientras las cardiopatías adquiridas resultan menos frecuentes. La expresión clínica difiere en gran manera de la población adulta y representa la emergencia cardiovascular más frecuente en pediatría. El diagnóstico es completamente clínico, y el tratamiento está encaminado a corregir la causa que la origina. Objetivo: Actualizar conceptos, fisiopatología, manifestaciones clínicas, y tratamiento de la insuficiencia cardíaca en pediatría. Métodos: Se revisaron las bases de datos Medline, PubMed, SciELO y plataforma Springerlink, disponibles desde Infomed; desde el año 2000 hasta 2020, en idioma español e inglés. Análisis y síntesis de la información: La insuficiencia cardíaca es un síndrome clínico resultado de disfunción ventricular, sobrecarga de presión o volumen, independiente o en combinación, que conlleva a signos y síntomas característicos. La identificación de su causa, el diagnóstico precoz y el tratamiento oportuno mejoraran el pronóstico de los pacientes aquejados. Conclusiones: La insuficiencia cardíaca en edad pediátrica representa una compleja afección de causas multifactoriales. El diagnóstico puede hacerse con el método clínico, complementándose con los diferentes exámenes. El tratamiento médico farmacológico o no, se encamina a tratar la causa, además de nuevas terapias en desarrollo prometedoras en el futuro(AU)
Introduction: Congenital heart disease is a frequent cause of heart failure while acquired heart disease is less frequent. The clinical expression differs greatly from the adult population and represents the most frequent cardiovascular emergency in pediatrics. Diagnosis is completely clinical and treatment is aimed at correcting the cause. Objective: To update concepts, pathophysiology, clinical manifestations and treatment of heart failure in pediatrics. Methods: The databases Medline, PubMed, SciELO and Springerlink platform, available from Infomed, were reviewed from 2000 to 2020, in Spanish and English. Analysis and synthesis of the information: Heart failure is a clinical syndrome resulting from ventricular dysfunction, pressure or volume overload, independently or in combination, leading to characteristic signs and symptoms. Identification of its cause, early diagnosis and timely treatment improve the prognosis of afflicted patients. Conclusions: Heart failure in pediatric age represented a complex condition with multifactorial causes. The diagnosis can be made with the clinical method, complemented with different examinations. Pharmacological or non-pharmacological medical treatment is aimed at treating the cause, in addition to promising new therapies under development in the future(AU)
Subject(s)
Humans , Infant , Child, Preschool , Heart Defects, Congenital/etiology , Heart Failure/etiology , Heart Failure/physiopathology , Heart Failure/therapy , Heart Failure/epidemiology , Serial Publications , Extracorporeal Membrane Oxygenation/instrumentation , Clinical Laboratory Techniques/methods , Heart Auscultation , Heart Failure/classificationABSTRACT
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).
Subject(s)
Extracorporeal Membrane Oxygenation , Respiration, Artificial , Respiratory Distress Syndrome, Newborn , Cost-Benefit Analysis , ColombiaABSTRACT
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.
Subject(s)
Humans , Aged , Extracorporeal Membrane Oxygenation/methods , Ventilation/methods , Airway Obstruction/surgery , Extracorporeal Circulation/methodsABSTRACT
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]
Subject(s)
Humans , Extracorporeal Membrane Oxygenation , Pandemics , Patient Safety , Nursing CareABSTRACT
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.