[10 years experience with extracorporeal membrane oxygenation]. / Zehn Jahre Erfahrung mit extrakorporaler Membranoxygenierung (ECMO).

OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a supportive therapy used for severe acute respiratory distress syndrome (ARDS). We present outcome, clinical parameters, and complications in a cohort of 245 ARDS patients of whom 62 were treated with ECMO. METHODS: Data of all ARDS patients were prospectively collected between 1991 and 1999. Outcome and clinical parameters of patients treated with and without ECMO were evaluated. RESULTS: Hundred-thirty-eight patients were referred from other hospitals, 107 were primarily located in our hospital. About one fourth of these patients was treated with ECMO. The survival rate was 55% in ECMO patients and 61% in non-ECMO patients. ECMO resulted in very few complications, one of them was fatal. No parameter before or during ECMO could be used to predict the individual prognosis. CONCLUSION: ECMO is a therapeutic option for patients with severe ARDS, likely to increase survival. However, a randomized controlled study proving its benefit is still awaited. Until the development of a causal or otherwise superior therapy ECMO should be used in selected patients.

Communication and special health care needs of a profoundly hearing impaired adolescent.

This report describes the authors' experience in providing medical and contraceptive care to a profoundly hearing impaired adolescent in a hospital setting. Ways to communicate effectively with the hearing impaired are described.

PIP: According to a 1985 survey, at least 50,000 children and adolescents in the US are hearing impaired. The US Rehabilitation Act, PL 93-112, Section 504, mandates hospitals to establish a protocol for effective communication with hearing impaired persons in need of emergency health care. This requires that the hospital provide an interpreter with sign language skills. The profoundly hearing impaired adolescent should be encouraged to participate in all phases of health management and given a choice of mode of communicating. A parent may serve as a communication link between staff and adolescent, but this may be a barrier in obtaining a history with regard to confidential sexual activity. Hearing impaired adolescents face the same developmental tasks as their hearing counterparts, including sexual identity and expression, but their auditory limitations cause differences in their ability to acquire and transmit information on sexual matters. They generally perceive only the taboos and innuendos regarding sex and are vulnerable to sexual abuse. Many adolescents in residential facilities may need contraceptive services from health care providers who are not aware of the contraceptive needs of the hearing impaired. To increase such awareness, the authors present the case of an 18-year-old hearing impaired black female with pelvic inflammatory disease and a need for contraceptive counseling. Counseling was provided with the aid of a licensed sign language interpreter and included use of a 3-dimensional model of the female reproductive tract and a large flip chart illustrating birth control methods. Oral contraceptives were prescribed, and the patient was given the number of a telecommunication keyboard device for the deaf at the hospital in the event of problems.