Use of venous-venous extracorporeal membrane oxygenation in the treatment of postpartum pulmonary hypertension crisis.

The incidence of heart disease in pregnancy ranges from 0.5% to 3.0% and is regarded as one of the top three causes of maternal death. The mortality rate of patients with pulmonary hypertension and Eisenmenger syndrome is as high as 16.7%-50%. Changes in haemodynamics during pregnancy and childbirth increase the burden on the heart, and induced pulmonary hypertension crisis is one of the main causes of maternal death. Extracorporeal Membrane Oxygenation (ECMO) is the last-resort treatment strategy to treat patients with pulmonary hypertension crisis. We report a ventricular septal defect in a pregnant woman with pulmonary hypertension and Eisenmenger's syndrome, which is a postpartum pulmonary hypertension crisis that leads to respiratory and circulatory disorders. The patient was successfully treated with venous-venous extracorporeal membrane oxygenation.

ECMO for paediatric cardiac arrest caused by bronchial rupture and severe lung injury: a case report about life-threatening rescue at an adult ECMO centre.

BACKGROUND: Bronchial rupture in children is a rare but dangerous complication after chest trauma and is associated with increased mortality. Veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) is reported as one of the treatments for this life-threatening complication. CASE PRESENTATION: A 4-year-old boy with bronchial rupture and traumatic wet lung complicated by cardiac arrest after chest trauma was admitted to an adult ECMO centre. He experienced two cardiac arrests, one before and one during the operation. The total duration of cardiac arrest was 30 min. V-V ECMO was initiated because of severe hypoxia and hypercapnia during the operation. ECMO was performed for 6 days, and mechanical ventilation lasted 11 days. On the 31st day after surgery, he had recovered completely and was discharged without neurological deficit. CONCLUSION: V-V ECMO can be considered for supportive care in children with severe acute respiratory failure after bronchial rupture. In an emergency, V-V ECMO can be carried out effectively in a qualified and experienced adult ECMO centre. However, the application of ECMO in children is different from that in adults and requires more refined management.

ΔPCO2 and ΔPCO2/C(a-cv)O2 Are Not Predictive of Organ Dysfunction After Cardiopulmonary Bypass.

Background: Cardiac surgery is associated with a substantial risk of major adverse events. Although carbon dioxide (CO2)-derived variables such as venous-to-arterial CO2 difference (ΔPCO2), and PCO2 gap to arterial-venous O2 content difference ratio (ΔPCO2/C(a-cv)O2) have been successfully used to predict the prognosis of non-cardiac surgery, their prognostic value after cardiopulmonary bypass (CPB) remains controversial. This hospital-based study explored the relationship between ΔPCO2, ΔPCO2/C(a-cv)O2 and organ dysfunction after CPB. Methods: We prospectively enrolled 114 intensive care unit patients after elective cardiac surgery with CPB. Patients were divided into the organ dysfunction group (OI) and non-organ dysfunction group (n-OI) depending on whether organ dysfunction occurred or not at 48 h after CPB. ΔPCO2 was defined as the difference between central venous and arterial CO2 partial pressure. Results: The OI group has 37 (32.5%) patients, 27 of which (23.7%) had one organ dysfunction and 10 (8.8%) had two or more organ dysfunctions. No statistical significance was found (P = 0.84) for ΔPCO2 in the n-OI group at intensive care unit (ICU) admission (9.0, 7.0-11.0 mmHg), and at 4 (9.0, 7.0-11.0 mmHg), 8 (9.0, 7.0-11.0 mmHg), and 12 h post admission (9.0, 7.0-11.0 mmHg). In the OI group, ΔPCO2 also showed the same trend [ICU admission (9.0, 8.0-12.8 mmHg) and 4 (10.0, 7.0-11.0 mmHg), 8 (10.0, 8.5-12.5 mmHg), and 12 h post admission (9.0, 7.3-11.0 mmHg), P = 0.37]. No statistical difference was found for ΔPCO2/C(a-cv)O2 in the n-OI group (P = 0.46) and OI group (P = 0.39). No difference was detected in ΔPCO2, ΔPCO2/C(a-cv)O2 between groups during the first 12 h after admission (P > 0.05). Subgroup analysis of the patients with two or more failing organs compared to the n-OI group showed that the predictive performance of lactate and Base excess (BE) improved, but not of ΔPCO2 and ΔPCO2/C(a-cv)O2. Regression analysis showed that the BE at 8 h after admission (odds ratio = 1.37, 95%CI: 1.08-1.74, P = 0.009) was a risk factor for organ dysfunction 48 h after CBP. Conclusion : ΔPCO2 and ΔPCO2/C(a-cv)O2 cannot be used as reliable indicators to predict the occurrence of organ dysfunction at 48 h after CBP due to the pathophysiological process that occurs after CBP.

Effects of early enteral nutrition on the prognosis of patients with sepsis: secondary analysis of acute gastrointestinal injury study.

BACKGROUND: The time of enteral nutrition (EN) administration on patients with sepsis is controversial. The study was to explore the effect of early enteral nutrition (EEN) on the prognosis of patients with sepsis. METHODS: We performed a secondary analysis of the acute gastrointestinal injury grade study. The patients were divided into two groups from the time of EN administration: EEN group (n=85): EN within 24 hours; Control group (N=78): EN after 24 hours. The key observation was the length of ICU stay, and length of hospital stay, and 28- and 60-day mortality. RESULTS: Of 676 patients, 163 were included. There are no significant between-group differences in the characteristics at baseline. The overall mortality rate at 28 days in the EEN group was 28.2% vs. 43.6% in the control group (P=0.041). The mortality rate at 60 days in the EEN group was 36.5% vs. 52.6% in the control group (P=0.039). In a subgroup analysis of patients who whether used vasoactive drugs: the EEN group was found to be significantly associated with 60-day mortality (P=0.039). The ICU stay length in the EEN group was longer than in the control group {11 [8-22] vs. 10 [6-16]; P=0.022}. Also, the length of the hospital stay was longer than in the Control group {23 [14-53] vs. 18 [10-39]; P=0.023}. Univariate Cox regression analysis showed that EEN, using vasoactive drugs, Acute kidney injury (AKI), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the global acute gastrointestinal injury (AGI) grade were significantly (P<0.05) associated with 60-day mortality. In a multivariate analysis including these variables, EEN (HR1.68, 95% CI: 1.02-2.62; P=0.040, global AGI grade (HR2.28, 95% CI: 1.30-4.00; P=0.004), and APACHE II score (HR 1.04, 95% CI: 1.01-1.07; P=0.021) were independently associated with 60-day mortality. CONCLUSIONS: EEN within 24 hours can improve the survival of patients with sepsis, and that is an independent prognostic factor.