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1.
Resuscitation ; 83(5): 579-83, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22056265

RESUMO

OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) support has been suggested to improve the survival rate in patients with refractory in- and out-of-hospital cardiac arrest (IHCA and OHCA). The aim of our study is to report our experience with ECMO in these patients. DESIGN: Retrospective, single-centre, observational study. PATIENTS: From January 2006 to February 2011 we studied 42 patients (31 males) with refractory cardiac arrest. MEASUREMENT AND MAIN RESULTS: ECMO implantation was successful in 38 (90%) of the 42 patients. ECMO support was positioned: three times (8%) in the operating room, six (16%) in the cardiac surgery intensive care unit, 21 (55%) in the emergency room, five (13%) in the catheterisation laboratory and three (8%) in the general ward. A total of 14 IHCA (58%) and three OHCA (16%) patients were weaned from ECMO (p<0.05). Eleven IHCA (46%) and one OHCA (5%, p<0.05) patients were discharged from intensive care unit (ICU). Among IHCA patients, 10 were alive at 6 months, nine of whom (38%) with good neurological outcome. Among OHCA patients weaned from ECMO, one was alive at 6 months with good neurological outcome (5%, p<0.05 vs. IHCA). CONCLUSIONS: ECMO support should be considered as a resuscitation alternative in selected patients. More specifically, patients with witnessed IHCA benefit more from ECMO treatment compared to those who experience an out-of-hospital cardiac arrest.


Assuntos
Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/terapia , Parada Cardíaca Extra-Hospitalar/terapia , Adolescente , Adulto , Idoso , Reanimação Cardiopulmonar/mortalidade , Criança , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
2.
Stud Health Technol Inform ; 148: 206-21, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19745252

RESUMO

Defensive medicine takes place when healthcare personnel modify their behaviour with the aim of reducing their exposure to legal challenges from patients. The phenomenon is directly related to the significant growth in medical malpractice litigation over recent years. This article presents the results of two research surveys aimed at measuring the extent of defensive behaviours on the part of doctors in Italy and at understanding the reasons for them. The first study (the National Study (NS) was conducted in respect of a nation-wide sample of general practitioners, while the second (the Local Study (LS) was conducted in respect of two groups of specialists (surgeons and anaesthetists) in a regional hospital. 77.9% of the general practitioners interviewed for the NS (responses were received from 37% of the 1000 GPs to whom the questionnaire was sent) declared that they had practiced at least one form of defensive medicine during the previous working month. The figure for the LS was 83.3%. This article discusses the factors, such as the blame culture and the increase in medical malpractice litigation, that may lead to defensive behaviours and result in negative effects both in terms of costs and patient safety. A clear need emerges for a different approach to the problem of medical error - at a cultural, organizational and legal level - just as in the case of other organizations subject to high risk. The deterrent of punishment does not increase the reliability of such organizations, nor does it improve the level of safety in them.


Assuntos
Medicina Defensiva , Pesquisas sobre Atenção à Saúde , Adulto , Idoso , Medo , Humanos , Entrevistas como Assunto , Itália , Erros Médicos/prevenção & controle , Pessoa de Meia-Idade , Gestão da Segurança
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