1173: OUTCOMES AFTER ISOFLURANE AND EXTRACORPOREAL LIFE SUPPORT USE IN CHILDREN WITH NEAR-FATAL ASTHMA

Besides the conventional extracorporeal circulation, commonly used in cardiac surgery, the methods of extracorporeal life support (ECLS) have been applied ever more frequently in thoracic surgery in recent years. The most commonly used modalities of such supports include extracorporeal membrane oxygenation (ECMO) and the Novalung interventional lung assist device (iLA). Successful application of ECLS has led to its more frequent use in general thoracic surgery, especially as a tool to treat hypercapnia and to ensure oxygenation and haemodynamic support. However, these methods are essential in lung transplant programmes; without their help, in most cases, it would not be possible to perform the transplantatioz or prevent the severe complications associated with critical primary graft dysfunction. Additionally, the extracorporeal circulation also facilitates the performing of specific surgical procedures that would not be feasible under standard conditions or would be associated with an inadequate risk. The application of extracorporeal life supports can fundamentally increase the level of resection when treating advanced intrathoracic malignancies that are in close contact with the heart and large vessels or even directly extend into them. Without the possibility of resecting such structures en bloc, together with the tumour, and, thus, achieving an R0 resection, these malignant tumours are often directly contraindicated for surgery or are operated non-radically, i.e. unsuccessfully. Complete tumour resection is the most important prognostic factor in the surgery.

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Diagnosis of coronary affection in patients with AADA and treatment of postcardiotomy myocardial failure using extracorporeal life support (ECLS)

The Heart Surgery Forum ◽

10.1532/hsf98.2014397 ◽

2014 ◽

Vol 17 (5) ◽

pp. 253 ◽

Cited By ~ 3

Author(s):

Sabina P W Guenther ◽

Sven Peterss ◽

Angela Reichelt ◽

Frank Born ◽

Matthias Fischer ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery ◽

Life Support ◽

Extracorporeal Life Support ◽

Artery Bypass ◽

Preoperative Evaluation ◽

Left Heart Failure ◽

Myocardial Failure ◽

Coronary Abnormalities ◽

Ventricular Support

Background: Myocardial ischemia due to concomitant coronary artery disease (CAD) or coronary dissection in patients with acute aortic dissection type Stanford A (AADA) is associated with myocardial failure and poor outcomes. Preoperative coronary angiography in this group of patients is still debated. The use of CT scan to diagnose coronary affection along with the establishment of high-pitched dual-spiral CT protocols are essential for improving outcomes.Methods: We retrospectively analyzed six AADA patients with heart failure who were treated using extracorporeal life support (ECLS). Options for diagnosing coronary affection and different therapeutic strategies for postcardiotomy cardiogenic shock in this patient cohort are discussed.Results: Retrospective review of CT images showed coronary abnormalities in 83% (n = 5). Four patients (67%) underwent unplanned coronary artery bypass grafting (CABG). ECLS was instituted in 67% (n = 4) due to left heart failure and in 33% (n = 2) due to right heart failure. Thirty day mortality was 67% (n = 4). The two patients that received ECLS for right ventricular support survived and both had undergone CABG.Conclusion: Besides preoperative evaluation of the extent of the dissection, focus on coronary affection in CT-scans helps to triage the operative procedure. Hybrid operating rooms allow for immediate interventional and/or surgical treatment and enable for immediate control of revascularization results. The use of ECLS over other types of ventricular support systems may allow for myocardial recovery in selected cases.

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Potentially (near) fatal asthma

Allergy and Asthma Proceedings ◽

10.2500/aap.2019.40.4257 ◽

2019 ◽

Vol 40 (6) ◽

pp. 403-405 ◽

Cited By ~ 1

Author(s):

Paul A. Greenberger

Keyword(s):

Severe Asthma ◽

Health Care Professionals ◽

Rescue Therapy ◽

Respiratory Acidosis ◽

Acute Severe Asthma ◽

Increased Risk ◽

High Risk Type ◽

Fatal Asthma ◽

Long Acting ◽

Near Fatal Asthma

Potentially (near) fatal asthma (PFA) defines a subset of patients with asthma who are at increased risk for death from their disease. The diagnosis of PFA should motivate treating physicians, health professionals, and patients to be more aggressive in the monitoring, treatment, and control of this high-risk type of asthma. A diagnosis of PFA is made when any one of the following are present: (1) a history of endotracheal intubation from asthma, (2) acute respiratory acidosis (pH < 7.35) or respiratory failure from acute severe asthma, (3) two or more episodes of acute pneumothorax or pneumomediastinum from asthma, (4) two or more episodes of acute severe asthma, despite the use of long-term oral corticosteroids and other antiasthma medications. There are two predominant phenotypes of near-fatal exacerbations: “subacute” exacerbation and “hyperacute” exacerbation. The best way to “treat” acute severe asthma is 3‐7 days before it occurs (i.e., at the onset of symptoms or change in respiratory function) and to optimize control of asthma by decreasing the number of symptomatic days and the days and/or nights that require rescue therapy and increasing baseline respiratory status in “poor perceivers.” PFA is treated with a multifaceted approach; physicians and health-care professionals should appreciate limitations of pharmacotherapy, including combination inhaled corticosteroid‐long-acting β-agonist products as well as addressing nonadherence, psychiatric, and socioeconomic issues that complicate care.

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