The new role of the perfusionist in adult extracorporeal life support

Adult and pediatric extracorporeal life support (ECLS) has been transformed by the European1 and Australian 2 experiences with a reduction of the circuit to its most basic form (Figure 1). Many factors have converged at this point in time to allow us to offer this support. The availability in the U.S.A. of an advanced oxygenator (QuadroxD) (Maquet Inc., Bridgewater, NJ), long-term centrifugal pumps and circuit coatings offers us the means to provide ECLS. The other equally important factor is the intensivist trained in extracorporeal therapies. Once the intensive care unit registered nurse (ICU RN) is trained to safely and effectively manage both the patient and ECLS circuit, this support may be offered. The perfusionist is in an unique position to educate and mentor the ICU RN in ECLS. There is, perhaps, no one in a better position to explain this equipment and its uses in an interdisciplinary-oriented pediatric and adult ECLS program than a perfusionist.

Download Full-text

Veno-venous extracorporeal life support for blastomycosis-associated acute respiratory distress syndrome

Perfusion ◽

10.1177/0267659119844391 ◽

2019 ◽

Vol 34 (8) ◽

pp. 660-670

Author(s):

Abdulrahman Al-Fares ◽

Eddy Fan ◽

Shahid Husain ◽

Matteo Di Nardo ◽

Marcelo Cypel ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Life Support ◽

Extracorporeal Life Support

Background: Blastomyces is a dimorphic fungus endemic to regions of North America, which can lead to pneumonia and fatal severe acute respiratory diseases syndrome in up to 89% of patients. Extracorporeal life support can provide adequate oxygenation while allowing the lungs to rest and heal, which might be an ideal therapy in this patient group, although long-term clinical and radiological outcomes are not known. Clinical features: We report on five consecutive patients admitted to Toronto General Hospital intensive care unit between January 2012 and September 2016, with progressive respiratory failure requiring veno-venous extracorporeal life support within 24-96 hours following mechanical ventilation. Ultra-lung protective mechanical ventilation was achieved within 24 hours. Recovery was the initial goal in all patients. Extracorporeal life support was provided for a prolonged period (up to 49 days), and four patients were successfully discharged from the intensive care unit. Long-term radiological assessment in three patients showed major improvement within 2 years of follow-up with some persistent disease-related changes (bronchiectasis, fibrosis, and cystic changes). In two patients, long-term functional and neuropsychological outcomes showed similar limitations to what is seen in acute respiratory distress syndrome patients who are not supported with extracorporeal life support and in acute respiratory distress syndrome patients without blastomycosis, but worse pulmonary function outcomes in the form of obstructive and restrictive changes that correlated with the radiological imaging. Conclusion: Veno-venous extracorporeal life support can effectively provide prolonged support for patients with blastomycosis-associated acute respiratory distress syndrome that is safe and associated with favorable long-term outcomes.

Download Full-text

Extracorporeal Membrane Oxygenation: The First 10 Years Experience of a Portuguese Pediatric Intensive Care Unit

Acta Médica Portuguesa ◽

10.20344/amp.15227 ◽

2021 ◽

Vol 34 (6) ◽

pp. 435

Author(s):

Daniel Meireles ◽

Francisco Abecasis ◽

Leonor Boto ◽

Cristina Camilo ◽

Miguel Abecasis ◽

...

Keyword(s):

Intensive Care Unit ◽

Overall Survival ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Patients ◽

Life Support ◽

Extracorporeal Life Support ◽

Pediatric Intensive Care ◽

Overall Survival Rate ◽

Clinical Complications

Introduction: In Portugal, extracorporeal membrane oxygenation (ECMO) is used in pediatric patients since 2010. The aim of this study was to describe the clinical characteristics of patients, indications, complications and mortality associated with the use of ECMO during the first 10-years of experience in the Pediatric Intensive Care Unit located in Centro Hospitalar Universitário Lisboa Norte.Material and Methods: Retrospective observational cohort study of all patients supported with ECMO in a Pediatric Intensive Care Unit, from the 1st of May 2010 up to 31st December 2019.Results: Sixty-five patients were included: 37 neonatal (≤ 28 days of age) and 28 pediatric patients (> 28 days). In neonatal cases, congenital diaphragmatic hernia was the main reason for ECMO (40% of neonatal patients and 23% of total). Among pediatric patients, respiratory distress was the leading indication for ECMO (47% of total). The median length of ECMO support was 12 days. Clinical complications were more frequent than mechanical complications (65% vs 35%). Among clinical complications, access site bleeding was the most prevalent with 38% of cases. The overall patient survival was 68% at the time of discharge (65% for neonatal and 71% for pediatric cases), while the overall survival rate in Extracorporeal Life Support Organization registry was 61%. The number of ECMO runs has been increasing since 2011, even though in a non-linear way (three cases in 2010 to 11 cases in 2019).Discussion: In the first 10 years we received patients from all over the country. Despite continuous technological developments, circuitrelated complications have a significant impact. The overall survival rate in the Pediatric Intensive Care Unit was not inferior to the one reported by the Extracorporeal Life Support Organization.Conclusion: The overall survival of our Pediatric Intensive Care Unit is not inferior to one reported by other international centers. Our experience showed the efficacy of the ECMO technique in a Portuguese centre.

Download Full-text

The Role of Long-Term Electroencephalogram Monitoring in the Prognostic Evaluation of Children with Disturbance of Consciousness in Pediatric Intensive Care Unit

Tobacco Regulatory Science ◽

10.18001/trs.7.5.38 ◽

2021 ◽

Vol 7 (5) ◽

pp. 1214-1221

Author(s):

Xiaobo Wu ◽

Ruiqin Qiu ◽

Baoqi Li ◽

Heyuan Gao ◽

Ying Su

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Medical Records ◽

Compliance Rate ◽

Pediatric Intensive Care ◽

Prognostic Evaluation ◽

Disturbance Of Consciousness

This study aimed to investigate the role of long-term video electroencephalogram (VEEG) monitoring in the diagnosis and prognostic evaluation of children with disturbance of consciousness in pediatric intensive care unit (PICU). Materials and Methods : A retrospective analysis was performed on the medical records of 107 children with severe brain injury (SBI) who admitted to the PICU of The First Hospital of Qinhuangdao from January 2014 to December 2015. The medical records of 100 children with mild disturbance of consciousness were analyzed. All children underwent routine electroencephalogram (REEG) and VEEG detections. The diagnosis was completed by physicians according to the relevant operation instructions. The brain waveform of children was monitored. Result : The diagnostic results of REEG and VEEG were compared with clinical diagnostic results, and the relationship between the two detections and the prognosis of SBI children was analyzed. The sensitivity of VEEG in the diagnosis of SBI children was significantly higher than that of REEG (P<0.050). The specificity of VEEG in the diagnosis of SBI children was higher than that of REEG, with a statistical significance (P<0.050). The diagnostic compliance rate of VEEG in the diagnosis of SBI children was significantly higher than that of REEG (P<0.050). The sensitivity of VEEG in evaluating the prognosis of SBI children was significantly higher than that of REEG (P<0.050). The specificity of VEEG in evaluating the prognosis of SBI children was significantly higher than that of REEG. The coincidence rate of VEEG in evaluating the prognosis of SBI children was significantly higher than that of REEG (P<0.050). Conclusion: The results indicated that VEEG detection is effective in the diagnosis and prognostic evaluation of SBI children with disturbance of consciousness, which is worthy of promotion in clinical practice.

Download Full-text

Pediatric in–intensive-care-unit cardiac arrest: New horizon of extracorporeal life support

Critical Care Medicine ◽

10.1097/01.ccm.0000239431.59461.f8 ◽

2006 ◽

Vol 34 (10) ◽

pp. 2703

Author(s):

Christopher Parshuram

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Life Support ◽

Extracorporeal Life Support

Download Full-text

Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest

Yearbook of Critical Care Medicine ◽

10.1016/s0734-3299(08)70481-7 ◽

2008 ◽

Vol 2008 ◽

pp. 59-60

Author(s):

S. Trzeciak

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Life Support ◽

Medical Intensive Care Unit ◽

Extracorporeal Life Support ◽

Medical Intensive Care ◽

Refractory Cardiac Arrest

Download Full-text

Emotional Responses of Burned Children in a Pediatric Intensive Care Unit

Psychiatry in Medicine ◽

10.2190/8kjb-9539-9vvw-bacf ◽

1972 ◽

Vol 3 (1) ◽

pp. 59-65 ◽

Cited By ~ 6

Author(s):

Roslyn Seligman ◽

Shirley Carroll ◽

Bruce G. MacMillan

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Emotional Responses ◽

Pediatric Intensive Care ◽

Emotional Needs ◽

Clinical Observations ◽

Case Vignettes ◽

Thermal Injuries

A thirty-bed hospital for acute and reconstructive treatment of thermal injuries in children has afforded an opportunity to investigate: 1) early development and personality in the pre-burn child, 2) emotional responses to the injury and hospitalization, 3) the role of emotions in the clinical course of treatment, and 4) long-term adjustment to the physical and emotional trauma of burns. The focus is on clinical observations and evaluations made by a consultant in child psychiatry on a four-bed intensive care unit. The role of the intensive care unit environment, immobilization, and the interplay of patients on one another, as well as the environment-mind-body interrelationships, are illustrated by four case vignettes. Psychological thoughts regarding somatic responses of ulcers, hypertension, and central nervous system manifestations of hallucinatory-like and seizure-like phenomena are made. These vignettes attempt to show how the emotional needs of a burned child, especially in an intensive care unit, must receive the same emphasis as his physical needs.

Download Full-text

Facing Tragic Decisions With Parents in the Neonatal Intensive Care Unit: Clinical Perspectives

PEDIATRICS ◽

10.1542/peds.89.1.119 ◽

1992 ◽

Vol 89 (1) ◽

pp. 119-122

Author(s):

Michael S. Jellinek ◽

Elizabeth A. Catlin ◽

I. David Todres ◽

Edwin H. Cassem

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Life Support ◽

Ethical Guidelines ◽

Physician Family ◽

Extensive Body

Withdrawing a neonate's life supports and limiting resuscitation efforts are among the most complex, tragic, and stressful decisions faced by parents and physicians. There is an extensive body of literature discussing ethical and legal implications of such decisions.1-8 There is also a substantial body of literature on parental grieving, the risks of long-term depression and family dysfunction,9-12 and the inevitable stress on the pediatric team when dealing with critically ill infants.13-20 However, despite all that has been written, our own review has found little that addresses the clinical and psychological questions that the physician and family must face together during the several intense and intimate meetings where they actually decide to withdraw life support or limit resuscitation efforts. These questions will be most relevant for the senior members of the neonatal intensive care unit (NICU) team and should be part of the training of pediatric house officers, although the underlying principles are relevant to many of the decisions made by a pediatrician and family. For the purposes of this discussion we will assume that the appropriate legal and ethical standards are being observed in terms of the substance of the decision and will focus on the clinical process of physician-family decision making. We expect that technology will necessitate ongoing revisions of the legal/ethical guidelines but that the clinical goals of decision making will remain interpersonal, intimate, humane, respectful, and sensitive to long-term emotional concerns. The clinical context is loss. Grief replaces the family's hopes for a happy, healthy baby, their expectations of bringing a new baby into their home, and the dreams that come with raising this child.

Download Full-text

Sikeres extracorporalis membránoxigenizációs (ECMO-) kezelés Legionella-pneumoniában

Orvosi Hetilap ◽

10.1556/650.2019.31285 ◽

2019 ◽

Vol 160 (6) ◽

pp. 235-240 ◽

Cited By ~ 2

Author(s):

Ildikó Madurka ◽

Tibor Bartók ◽

Krisztina Kormosói-Tóth ◽

Nóra Schönauer ◽

Jenő Elek ◽

...

Keyword(s):

Intensive Care ◽

Life Support ◽

Extracorporeal Life Support ◽

Community Acquired Pneumonia ◽

Lung Protective Ventilation ◽

Volume Ventilation ◽

Permanent Improvement ◽

Refractory Hypoxemia ◽

Venovenous Ecmo

Abstract: The mortality of severe ARDS is almost 60%. Ventilation-associated lung-injury can be avoided by low-pressure, low-volume ventilation. Potential use of ECMO in case of refractory hypoxemia beside modern ventilatory therapy can be considered. Increasing numbers of respiratory ECMO runs are seen worldwide, though the efficacy remains controversial. The authors present the first successful venovenous-ECMO treatment in severe ARDS in our Institute. We report the case of a 67-year-old male who was admitted with community-acquired pneumonia caused by Legionella. Despite empirical and later targeted antibiotic therapy, severe ARDS with sepsis evolved. Neither ventilation nor prone position resulted in permanent improvement in oxygenation. The patient was referred to our Institute for extracorporeal life support (ECLS) therapy. On admission, blood gas showed severe hypoxemia with mild hypercapnia (PaO2/FiO2: 60, pCO2: 53 mmHg at PEEP: 14 mmHg, PIP: 45 mmHg). X-ray showed bilateral patchy infiltrates while cardiac impairment (EF: 45%) and dilated right ventricle were seen on echocardiography. Elevated pulmonary artery pressure (mPAP: 41 mmHg) was measured. After implantation of femoral-jugular VV ECMO, oxygen saturation was appropriate with lung protective ventilation (FiO2: 0.5, TV: 3–4 ml/kg). Improving lung function enabled us to stop ECMO after 8 days and further 5 days later the patient was weaned off ventilation. After 21 days of intensive care we discharged him to the referral hospital. By reporting this case we emphasise the potential role of respiratory ECMO. Consideration should be given to increase the contingent of this modality in the Hungarian intensive care in accordance with international practice. Orv Hetil. 2019; 160(6): 235–240.

Download Full-text