Traslado aéreo de un paciente con insuficiencia cardíaca conectado a ECMO / Air transfer of a heart failure patient on ECMO

El traslado aéreo con ECMO es una forma segura y eficaz de trasladar pacientes para obtener mejores opciones terapéuticas. Este caso clínico ilustra la factibilidad, de este modo de apoyo al tratamiento de pacientes críticos, en este caso de una valvulopatía con indicación quirúrgica.

Air transfer of patients on ECMO is a safe mode to allow for treatment of patients located in places with limited resources for intensive care treatments in cardiovascular disease. The present case illustrates the feasibility and conditions required to implement the procedure. The case herein reported was a patient with severe valvular heart disease requiring surgery.

Use of extracorporeal membrane oxygenator support to salvage an infant with anomalous left coronary artery from pulmonary artery.

Anomalous left coronary artery from pulmonary artery (ALCAPA) is a congenital acyanotic heart disease where the left coronary artery (LCA) arises from the pulmonary artery. This results in the LCA receiving blood supply from the low-pressure right ventricle having minimal extractable oxygen. The oxygen delivery to the left ventricle (LV) is severely hampered causing severe hypoxic LV dysfunction early in life. Early surgery prior to serious, irreversible LV dysfunction is the key to survival. Children with ALCAPA usually present in their first few weeks of life, with severe LV dysfunction. After surgical correction of the defect, the myocardium may not recover early from the presurgery myocardial dysfunction. We describe a case where extracorporeal membrane oxygenator was utilized as a means of ventricular support during this critical postoperative period resulting in a favorable outcome.

Cuidado de enfermagem a uma paciente em uso da ECMO / Nursing care of an ECMO patient / Cuidados de enfermería a una paciente en el uso de ECMO

Este artigo tem como objetivos apresentar e discutir a experiência vivenciada no cuidado a uma paciente comSíndrome do Desconforto Respiratório Agudo (SDRA), submetida à oxigenação por membrana extracorpórea(ECMO); e apresentar os diagnósticos e cuidados de enfermagem implementados, discutindo-os, tomando-se comoreferência a literatura nacional e internacional sobre o tema. Trata-se de uma pesquisa qualitativa exploratória,do tipo estudo de caso instrumental, retrospectivo e documental. Utilizou-se o prontuário da paciente para coletade dados, por meio de formulários estruturados. Os diagnósticos de enfermagem levantados foram baseados naTaxonomia II da NANDA. Foram encontrados 10 diagnósticos de enfermagem e implementadas 15 condutas. Todasestão de acordo com o preconizado na literatura, exceto a não utilização do sabão com clorexidina na lavagemdas mãos, antes e após contato com o paciente. A despeito do desfecho desfavorável, a assistência de enfermagemmostrou-se de qualidade, uma vez que foi sistematizada e embasada na literatura nacional e internacional sobreECMO.

This article aims to present and discuss the experience in the care of a patient with acute respiratory distress syndrome(ARDS), subjected to extracorporeal membrane oxygenation (ECMO), and to present the diagnoses and nursing careimplemented, discussing them, taking as a reference the national and international literature on the subject. It isa qualitative exploratory and retrospective case study. The medical records of the patient were used to collect datathrough structured forms. The nursing diagnoses used were based on NANDA Taxonomy II. There were found 10nursing diagnoses and 15 procedures were implemented. All diagnosis is in accordance with the recommendationsin the literature, except not using chlorhexidine soap in hand washing before and after contact with the patient.Despite the unfavorable outcome, nursing care proved to be of quality because it was based on systematic nationaland international literature on ECMO.

Este artículo tiene como objetivo presentar y discutir la vivencia en el cuidado de un paciente con síndrome demalestar respiratorio agudo (SDRA), sometido a la oxigenación por membrana extracorpórea (ECMO), y presentarlos diagnósticos y los cuidados de enfermería implementados, discutiéndolos, tomando como referencia a la literaturanacional e internacional sobre el tema. Se trata de una investigación exploratoria cualitativa, de tipo instrumental,retrospectivo y documental. Para la recolecta de datos se utilizó la historia clínica del paciente mediante formulariosestructurados. Los diagnósticos de enfermería fueron analizados sobre la base de la taxonomía II de la NANDA.Fueron encontrados 10 diagnósticos de enfermería y 15 conductas implementadas. Todos están de acuerdo con lopreconizado en la literatura, a excepción de la falta de uso del jabón con clorhexidina en el lavado de manos, antesy después del contacto con el paciente. A pesar del resultado desfavorable, la asistencia de enfermería resultó ser decalidad, ya que fue sistematizada y basada en la literatura nacional e internacional sobre el ECMO.

Successful Resuscitation of Prolonged Cardiac Arrest Using Emergency Extracorporeal Membrane Oxygenator: A case report / 대한마취과학회지

42-year-old woman who had suffered cardiac arrest because of hypovolemic shock was intractable to conventional cardiopulmonary resuscitation (CPR). After 34 minutes of CPR, we decided to start extracorporeal membrane oxygenator (ECMO) in order to provide adequate cerebral and coronary perfusion. She received hysterectomy and bleeding control for 2 hours 30 minutes, and three hours after the operation, she weaned from the 362 minutes ECMO support successfully and was extubated 12 hours after ECMO weaning on postoperative 1st day. She revealed no neurologic deficit on neurologic examination and electroencephalography. Her cardiac function was decreased when the initial ECMO support was started, but improved into normal status. She suffered from skin burn on defibrillation site, generalized myalgia, and ileus, but was discharged from the hospital without major complications on postoperative 17th day. Extracorporeal cardiopulmonary resuscitation (ECPR) in patients who did not respond conventional CPR can be a feasible option in selected patients.

Investigation and Development of Membrane Oxygenator / 医疗卫生装备

Based on the advantage of artificial lung, the background, principle and materials of membrane oxygenator are descried briefly. Besides, the purpose of ECC, ECMO, IVOX and TAL, advantage and disadvantage, newest re-search progress of the oxygenator are introduced. The aspects of IVOX and TAL can be modified, and the significance of TAL as to be the real artificial lung is pointed out. By anticipating the development trend of the oxygenator, the feature of ideal artificial lung and the study in the future can be summarized.

Prolonged Extracorporeal Lung Heart Assist ( Extracorporeal Membrane Oxygenation ) - 4 cases report / 대한마취과학회지

The extracorporeal membrane oxygenation(ECMO) for acute respiratory distress, syndrome was started in Korea from 1990. Until now there were 4 clinical cases in Korea. Three cases were cardiac patients who received the open heart surgery and one was lung contusion patient by a automobile accident. Among them one case survived after 90 hours ECMO and became the first successful ECMO case in Korea and also the first in Asia except Japan. In this case we used new anticoagulant nafamostat mesilate in order to reduce the subcutaneous bleeding. All the oxygenators were membrane type. The last one was the heparin-bonded microporous membrane type which was made for the cardiopulmonary bypass of open heart surgery. The last case showed the possibility of the use of microporous membrane oxygenator for prolonged extracorporeal membrane oxygenation without administration of the anticoagulation. We believe that the ECMO will become popular as a prolonged life supporting method in near future in Korea.