Therapeutic options for severe, refractory status asthmaticus: inhalational anaesthetic agents, extracorporeal membrane oxygenation and helium/oxygen ventilation

Despite improvements in supportive care, the mortality and morbidity of asthma remain constant. The risks and incidence of morbidity related to barotrauma remain high in patients that require mechanical ventilation. The authors present three alternative strategies including the inhalation of anaesthetic agents, helium/oxygen ventilation, and extracorporeal membrane oxygenation which may be beneficial when 'conventional therapies' fail in the intubated patient with status asthmaticus.     

Extracorporeal membrane oxygenation for postcardiotomy mechanical cardiovascular support in children with congenital heart disease

Extracorporeal membrane oxygenation (ECMO) is increasingly used to support postcardiotomy cardiorespiratory failure in children with congenital heart disease. We report on survival outcomes and factors associated with survival for postcardiotomy ECMO patients.     

重症急性呼吸窘迫综合征ECMO治疗的护理

目的 总结应用体外膜肺氧合（Extracorporeal Memberane Oxygenation，EcMo）技术救治22例重症急性呼吸窘迫综合征（ARDS）患者的治疗效果和护理经验。方法 分析22例机械通气效果不佳的ARDS患者采用静脉-静脉转流（V-V）模式进行ECMO治疗前后血流动力学和氧代谢的变化。结果 应用体外膜肺氧舍后，患者氧代谢情况明显改善，血流动力学变化不大，16例患者治愈，救治率为72．7％。6例患者死亡，3例死于继发脑干损伤，3例死于多脏器功能衰竭。结论 ECMO为治疗重症ARDS的一种有效手段，在护理中应严格控制转流速度和呼吸机参数，密切监测基础指标、出凝血时间、加强病情的观察和护理，预防并发症发生。     

二氧化碳血液净化仪实验研究

目的探讨气体传输型二氧化碳血液净化仪在呼吸衰竭(RF)治疗中实施体外膜肺氧合(ECMO)部分循环支持的实验研究。方法建立实验犬的RF模型,用BaxterEF-550血管路连接二氧化碳血液净化仪,股静脉置入双腔单针导管行V-V转流,转流过程中维持血流量200mL/min,氧入通入量4L/min~6L/min,转流开始10min后,分别采集动脉血及膜式人工肺出入端血标本,以后每转流60min分别采集血标本进行血气分析。结果人工肺出入端PCO2可由50.93mmHg±1.62mmHg~63.27mmHg±0.46mmHg下降为1.27mmHg±0.05mmHg~14.07mmHg±1.86mmHg,PO2上升值为371.6mmHg±42.67mmHg~614.6mmHg±50.35mmHg,人工肺出入端PCO2、TCO2、PO2、SO2、O2-C变化均有显著性差异(P<0.01)。转流60min,实验犬体动脉血PaO2从39.6mmHg,升高为56.7mmHg±2.36mmHg,PCO2由52.8mmHg下降为50.4mmHg±0.53mmHg。结论二氧化碳血液净化仪有良好的二氧化碳血液净化和氧传输双重性能;二氧化碳血液净化仪的气体传输性能,在0.2L/min流量时,可以使活体实验动物血气发生改变———氧摄入和二氧化碳排出增多,从而简化了ECMO技术并实现呼吸支持的作用,为呼吸衰竭的救治提供一项新的技术和途径。     

Use of VA ECMO and percutaneous palliation of ductal dependent coarctation in a neonate with trisomy 21 and COVID-19 pneumonia

We present a case of a neonate with trisomy 21, ductal-dependent aortic coarctation, and severe respiratory failure secondary to coronavirus disease 2019 (COVID-19) pneumonia. The neonate was managed with venoarterial extracorporeal membrane oxygenation (VA ECMO), palliative stenting of the coarctation, and a vascular plug occlusion of a large patent ductus arteriosus. The patient was successfully weaned off extracorporeal membrane oxygenation (ECMO). The patient is currently awaiting a definitive surgical repair in the near future.     

Documento de consenso SEDAR/SECCE sobre el manejo de ECMO

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 centers experience with the goal of improving comprehensive patient care.     

How often is extracorporeal membrane oxygenation needed in cases of congenital diaphragmatic hernia?

Some newborns with congenital diaphragmatic hernia (CDH) and severe pulmonary hypertension cannot be saved by conventional treatment and may obtain some benefit from extracorporeal membrane oxygenation (ECMO) as a bridging measure until adequate hematosis is possible. Early prediction of the insufficiency of optimal assistance is still unclear; we reviewed our recent experience with CDH patients in an attempt to evaluate the real need for ECMO in our institution. Between 1987 and 1994, 47 newborns with CDH manifested in the first 24 h were treated with maximal ventilatory assistance (including high-frequency ventilation in 12 cases) and vasoactive drugs prior to surgical repair. In order to summarize the ventilatory and blood-gas parameters, we determined oxygenation index (OI) and ventilatory index (VI) and compared the results in survivors and nonsurvivors. Overall survival was 60% (2 cases of Fryns' syndrome were excluded from analysis). OI was 10.3±5.7 (mean ± SD) for survivors and 46.2 ± 37.8 for nonsurvivors (P < 0.01). VI was 460.9±303 and 1,532±500.6, respectively (P <0.01). Bayesian analysis and receiver operating characteristic curves enabled us to select a threshold value of OI of 20 as the best means of predicting survival in our current conditions (sensitivity: 0.7, specificity: 0.83). The generally accepted figure of 40 had a sensitivity of 1 but a specificity of only 0.44. For VI, the best threshold value was 1,100 (sensitivity: 0.93, specificity: 0.94), whereas the generally used figure of 1,000 had 0.89 and 1, respectively. According to our results, with our current management conditions, approximately 50% of our CDH patients might have obtained some benefit from ECMO.