SEDAR/SECCE ECMO management consensus document.

ECMO is an extracorporeal cardiorespiratory support system whose use has been increased in the last decade. Respiratory failure, postcardiotomy shock, and lung or heart primary graft failure may require the use of cardiorespiratory mechanical assistance. In this scenario perioperative medical and surgical management is crucial. Despite the evolution of technology in the area of extracorporeal support, morbidity and mortality of these patients continues to be high, and therefore the indication as well as the ECMO removal should be established within a multidisciplinary team with expertise in the area. This consensus document aims to unify medical knowledge and provides recommendations based on both the recent bibliography and the main national ECMO implantation centres experience with the goal of improving comprehensive patient care.

Perforación de la pared del ventrículo izquierdo por catéter de arteria pulmonar Swan-Ganz. A propósito de un caso / Perforation of the left ventricle wall due to the insertion of a pulmonary artery catheter. A case report

A pesar de la extendida y frecuente utilización del catéter de arteria pulmonar en nuestro medio para el manejo hemodinámico en pacientes críticos y particularmente en pacientes tras cirugía cardiaca, en la actualidad siguen planteándose dudas sobre la necesidad de su uso. Es preciso valorar el riesgo/beneficio de su colocación y tener en cuenta sus posibles complicaciones, que aun siendo poco frecuentes, pueden llegar a ser potencialmente graves. En este artículo exponemos una complicación muy poco frecuente ocurrida en nuestro centro sobre el uso del catéter de arteria pulmonar de la que no teníamos constancia hasta ahora. Se trata de una perforación del tabique interventricular y de la pared libre del ventrículo izquierdo debido a una acodadura firme del catéter de arteria pulmonar, que no fue sospechada ni diagnosticada salvo por la visión directa del corazón, tras la esternotomía, durante la cirugía cardiaca. La mejora de la seguridad del paciente implica reflexionar sobre el valor de los eventos adversos, de manera que al aumentar la conciencia de la situación y del mecanismo por el que se producen, pueda reducirse la probabilidad de repetición

Despite the widespread and frequent use in our setting of pulmonary artery catheters for haemodynamic management in critically ill patients, particularly after heart surgery, some experts continue to question the need for these devices. Clinicians need to weigh up the risks and benefits of pulmonary artery catheters placement and bear in mind the potential complications which, though rare, can be potentially fatal. We present a pulmonary artery catheters-related complication not hitherto described in the literature, involving perforation of the interventricular septum and left ventricular free wall caused by a kink in the pulmonary artery catheters that was not suspected, and only diagnosed by direct vision of the heart after pericardial opening. In the interest of patient safety, we must consider the impact of adverse events; improving our situational awareness and our understanding of the mechanisms behind such events can help reduce the likelihood of repetitions in the future

Perforation of the left ventricle wall due to the insertion of a pulmonary artery catheter. A case report. / Perforación de la pared del ventrículo izquierdo por catéter de arteria pulmonar Swan-Ganz. A propósito de un caso.

Despite the widespread and frequent use in our setting of pulmonary artery catheters for haemodynamic management in critically ill patients, particularly after heart surgery, some experts continue to question the need for these devices. Clinicians need to weigh up the risks and benefits of pulmonary artery catheters placement and bear in mind the potential complications which, though rare, can be potentially fatal. We present a pulmonary artery catheters-related complication not hitherto described in the literature, involving perforation of the interventricular septum and left ventricular free wall caused by a kink in the pulmonary artery catheters that was not suspected, and only diagnosed by direct vision of the heart after pericardial opening. In the interest of patient safety, we must consider the impact of adverse events; improving our situational awareness and our understanding of the mechanisms behind such events can help reduce the likelihood of repetitions in the future.

Can 18F-FDG-PET show differences in myocardial metabolism between Wistar Kyoto rats and spontaneously hypertensive rats?

Positron emission tomography (PET) is useful for evaluating the cardiac metabolism of free fatty acid, glucose and oxygen both in human clinical practice and in experimental animal models. However, no data are available for such an evaluation in a model of stable compensated left ventricular hypertrophy in 14-month-old spontaneously hypertensive rats (SHRs). This study was designed to assess the metabolism of myocardial glucose in SHRs using 2-deoxy-2-[18F]fluoro-D-glucose ((18)F-FDG) using PET. The study was performed on 14-month-old male SHRs (n = 4) and age-matched Wistar Kyoto (WKY) rats (n = 4). PET scans were performed after the administration of anaesthesia with isoflurane and injection of a bolus of 39.37 ± 3.25 (mean ± SD) MBq (1.06 mCi) of (18)F-FDG. The standardized uptake value (SUV) was used to evaluate (18)F-FDG uptake by the heart. The analysis of SUV showed increased metabolism in the left ventricle of SHRs compared with WKY rats. Our results show that small animal PET using (18)F-FDG can be performed in 14-month-old SHRs to evaluate new therapies in the regression of left ventricular hypertrophy in SHRs because pathological myocardial metabolism in the SHR differs from the normal metabolism of the WKY rat.

Filogenia de la articulación de la cadera. Plasticidad del fenotipo. ¿Paradigma Lamarckiano o Darwiniano? Parte II / Hip Joint phylogenesis. Phenotypic plasticity. Lamarckian or Darwinian paradigm? Part II

Objetivo. El objetivo de este trabajo es analizar el origen de los cambios plásticos del fenotipo en una estructura biológica, en nuestro caso la cadera. Como hipótesis de trabajo se presenta la posibilidad de que los cambios se puedan interpretar según el paradigma Lamarckiano, en contraposición al paradigma Darwiniano. La sección material y método del trabajo se menciona en la parte I. Se han añadido estudios de plantas y peces. Discusión. Los resultados muestran que el diseño de la cadera, como relación de bola y cuenco, no cambia. El fenotipo, en los elementos que costituyen los tejidos de la articulación de la cadera, muestra cambios plásticos significativos. Conclusión. Sugerimos: que los cambios de la plasticidad del fenotipo de la cadera son inmanentes al fenotipo, y no se interpretan según el paradigma Lamarckiano ni Darwiniano (AU)

Objective. The aim of this work is to analyse the origin of phenotypic plastic changes into a biologic structure, in this case the hip. As a hypothesis of the work, the possibility that changes could be explained following the Lamarckian paradigm, opposed to the Darwinian paradigm, is shown. The section material and methods of this work have been published in part I. Studies in plants and fish have been added. Discussion. Results showed that the ball-and-socket design of the hip joint remains unchanged. Phenotype in the elements that form the hip joint tissues showed significant plastic changes. Conclusion. Interpretation of our results suggest that changes in phenotype plasticity of the hip joint are immanent to phenotype and cannot be explained by following Lamarck's or Darwin's paradigm (AU)

[Hip Joint phylogenesis. Phenotypic plasticity. Lamarckian or Darwinian paradigm? Part II]. / Filogenia de la articulación de la cadera. Plasticidad del fenotipo. ¿Paradigma Lamarckiano o Darwiniano? Parte II.

OBJECTIVE: The aim of this work is to analyse the origin of phenotypic plastic changes into a biologic structure, in this case the hip. As a hypothesis of the work, the possibility that changes could be explained following the Lamarckian paradigm, opposed to the Darwinian paradigm, is shown. The section material and methods of this work have been published in part I. Studies in plants and fish have been added. DISCUSSION: Results showed that the ball-and-socket design of the hip joint remains unchanged. Phenotype in the elements that form the hip joint tissues showed significant plastic changes. CONCLUSION: Interpretation of our results suggest that changes in phenotype plasticity of the hip joint are immanent to phenotype and cannot be explained by following Lamarck's or Darwin's paradigm.

Severe hypoxaemia with a left ventricular assist device in a minipig model with an undiagnosed congenital cardiac disease.

We describe the placement of a left ventricular assist device (LVAD) in a pig with spontaneously occurring atrial septal defect (ASD) (incidental finding) that created a right-left cardiac shunt, with subsequent severe hypoxaemia. Early diagnosis was critical in order to prevent end-organ damage due to hypoxaemia. Adequate monitoring alerted us to the deterioration in oxygenation, haemodynamics and cerebral oxygen metabolism. This forced us to change the level of assistance provided by the pump, and thus dramatically correct this impairment. Necropsy revealed an ostium secundum ASD. In conclusion, if hypoxaemia presents after implementation of an LVAD, the presence of a right-left shunt must be ruled out. The first step must be a judicious reduction in assist device flow to minimize intracardiac shunting. Subsequently, atrial septal closure of the defect should be considered. We report an experimental model of severe hypoxaemia after placement of an LVAD as part of a larger research project.

Anestesia subaracnoidea para una cesárea urgente en la enfermedad de Charcot-Marie-Tooth / Subarachnoid anesthesia for an emergency cesarean delivery in a patient with Charcot-Marie-Tooth disease

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[Intraoperative diagnosis of a mediastinal paraganglioma: Anesthetic management]. / Diagnóstico intraoperatorio de un paraganglioma mediastínico: manejo anestésico.

A 45-year-old woman with a posterior mediastinal tumor underwent right thoracotomy for resection, developing hypertension and difficult-to-control tachycardia while the tumor was being manipulated. A catecholamine-secreting tumor was suspected, the operation halted, and the patient prepared for surgery at a later time. The tumor was a mediastinal paraganglioma and the final outcome was satisfactory. Risk related to anesthesia is high in such patients, with perioperative mortality ranging from 40 to 85%. Correct diagnosis and appropriate preoperative drug preparation with adrenergic receptor blockers appreciably decreases morbidity and mortality related to surgery. We discuss the effect of labetalol on such tumors and describe our observations.