scholarly journals Experience of extracorporeal membrane oxygenation in obstetrics and gynecology

2019 ◽  
pp. 6-11
Author(s):  
A. A. Skopets
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Pregnant Women ◽  
Postpartum Period ◽  
Clinical Results ◽  
Pulmonary Insufficiency ◽  
Fetal Survival ◽  
Membrane Oxygenation ◽  
Results Of Treatment ◽  
Thrombotic Complications ◽  
The Mean

Objectives. In severe cardiac and pulmonary insufficiency extracorporeal membrane oxygenation (ECMO) is increasingly used in gynecological, pregnant and postpartum patients, although the management of such patients and clinical results remain underestimated. This study presents the experience of ECMO in gynecological and obstetric patients in the peripartal period.Methods. This study included all obstetric, pregnant or postpartum patients who received ECMO support in the Department of anesthesiology and intensive care unit between 1 November 2009 and 1 September 2019. The data were analyzed retrospectively. The preliminary task was to describe the circumstances and clinical characteristics of patients receiving ECMO, describe the management of such patients during pregnancy, childbirth and the postpartum period, evaluate the results of treatment of mothers and fetuses and report bleeding and thrombotic complications.Results. During the study period, seven obstetric and gynecological patients were treated with ECMO. Including two pregnant, 4 postpartum and 1 gynecological. The mean age was 27.0 years and the average gestational age of pregnant women was 27.5 weeks. Five patients (71.4%) were discharged from the hospital with full recovery. The fetal survival rate in the group of pregnant and postpartum 85 was 5 (80,8%). One patient was successfully delivered to ECMO. Hemorrhagic complications developed in 3 patients (42.8%) and were associated with disseminated intravascular coagulation. There were no complications in the fetus associated with ECMO.Summary. In the work of a multidisciplinary team of experienced specialists ECMO can be used in gynecology, in pregnant women and in the postpartum period, outweighing the risks of bleeding or thrombosis, with favorable results for the mother and fetus. 

Matrixplasty for the Treatment of Severe Incurved Toenail with Growth Plate Deformity

2012 ◽  
Vol 102 (3) ◽  
pp. 198-204
Author(s):  
J.-Young Kim
Keyword(s):  
Growth Plate ◽  
Clinical Results ◽  
New Technique ◽  
Partial Removal ◽  
Edge Angle ◽  
Results Of Treatment ◽  
The Mean ◽  
A New Technique ◽  
Ingrown Toenails

Background: Severely incurved toenails are accompanied by deformity of the toenail growth plate. In such a condition, partial removal of the nail and nail bed and simple unfolding of the nail itself frequently result in the recurrence of symptoms. We sought to design and develop a new technique for the treatment of incurved toenail with growth plate deformity and to report the results of treating this disease entity. Methods: Forty consecutive patients (52 cases) underwent treatment of symptomatic incurved toenails with a new technique named matrixplasty. The mean ± SD patient age was 40.3 ± 18.9 years. Last follow-up was at a mean ± SD of 18.0 ± 1.3 months. An American Orthopedic Foot and Ankle Society (AOFAS) forefoot hallux score was assigned, and patients were evaluated before treatment and at last follow-up. Patient satisfaction and the recurrence rate of the deformity were evaluated. For evaluation of improvement in toenail shape, the center to edge angle of the toenail was measured before treatment and at last follow-up. The complication rate was also evaluated. Results: All of the ingrown toenails healed, and the nail deformities were corrected within 3 weeks after the procedure. None of the incurved toenails had recurred by last follow-up. The mean pretreatment AOFAS forefoot hallux score was 72.9, and it improved to 99.6 by last follow-up (P < .001). Every patient was very satisfied or satisfied with the results of treatment. The mean ± SD center to edge angle of the toenail improved from 53.3° ± 9.5° to 15.3° ± 5.2° by last follow-up (P < .001). Minor paronychia, which was managed with local wound dressing and oral antibiotics, was identified in four cases. No other complication was identified. Conclusions: Matrixplasty showed excellent clinical results in the treatment of severe incurved toenail, and this newly developed procedure showed improvement of the deformed toenail and its growth plate. (J Am Podiatr Med Assoc 102(3): 198–204, 2012)

Ten Years of Extracorporeal Membrane Oxygenation: Neurodevelopmental Outcome

PEDIATRICS ◽  
1991 ◽  
Vol 87 (4) ◽  
pp. 549-555
Author(s):  
Dena Hofkosh ◽  
Heidi M. Feldman ◽  
Ann E. Thompson ◽  
Robert J. Nozza ◽  
Susan S. Kemp ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
High Frequency ◽  
Neurodevelopmental Outcome ◽  
Cognitive Testing ◽  
Neurologic Examination ◽  
Cognitive Score ◽  
School Aged Children ◽  
Membrane Oxygenation ◽  
The Mean

Of the 87 survivors of extracorporeal membrane oxygenation over a 10-year period, 67 participated in a follow-up study which included neurologic examination (n = 67), cognitive testing (n = 67), and audiologic assessment (n = 33). Matched control subjects for those older than 5 years were also evaluated. Outcome was defined as normal for cognitive scores ≥85 and normal neurologic examination results, suspect for cognitive scores 70 through 84 or nonfocal neurologic findings such as hypertonia/hypotonia, and abnormal for cognitive scores <70 or abnormal neurologic examination results. Of the 10 school-aged children studied, 9 were normal and there were no differences in mean cognitive scores between subjects and controls (IQ subjects = 109 ± 12 [SD], IQ controls = 107 ± 13). For preschoolers aged 2.7 through 4.11 years, the mean cognitive score was 91 ± 11 and 7 (70%) were normal. For infants 6 through 30 months, the mean cognitive score was 101 ± 22 and 27 (57%) were normal. A total of 7 children (21% of those studied) had abnormal audiologic assessments. Three children demonstrated mild high-frequency and 4 moderately severe high-frequency sensorineural hearing loss which was bilateral in 3 and of undetermined laterality in 1. Abnormal neurodevelopmental outcome was significantly associated with cerebral infarction and chronic lung disease. Outcome was not related to demographic or perinatal variables, illness severity prior to extracorporeal membrane oxygenation, or underlying diagnosis. Neurodevelopmental outcome among survivors of extracorporeal membrane oxygenation in this series is consistent with previous reports of morbidity among neonates with severe respiratory failure treated conventionally.

Discussion issues of management of pregnant women with thrombocytopenia

2021 ◽  
Vol 69 (6) ◽  
pp. 131-139
Author(s):  
Olga L. Mysik
Keyword(s):  
Pregnant Women ◽  
Postpartum Period ◽  
Risk Group ◽  
Perinatal Complications ◽  
Bleeding Events ◽  
Thrombotic Complications ◽  
Methods Of Treatment

The study of the pathogenesis of thrombocytopenia during pregnancy remains a very important problem, since hemostatic abnormalities continue to occupy one of the leading places among the causes of infertility, miscarriage and a large number of perinatal complications. Pregnant women with thrombocytopenia constitute a risk group for the development of bleeding events and thrombotic complications during pregnancy, in childbirth, and in the postpartum period. This article reviews literature data on the pathogenic causes of thrombocytopenia during pregnancy and on the main methods of treatment of the disease.

scholarly journals Delaying Decannulation After Extracorporeal Membrane Oxygenation Is Safe and Advantageous

2019 ◽  
Vol 10 (1) ◽  
pp. 98-100 ◽  
Author(s):  
Jess L. Thompson ◽  
Elaine Griffeth ◽  
Nicholas Rappa ◽  
Colette Calame ◽  
Robert W. Letton ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Adverse Outcomes ◽  
Ecmo Support ◽  
Time Interval ◽  
Single Patient ◽  
Children's Hospital ◽  
Membrane Oxygenation ◽  
The Mean ◽  
Systemic Anticoagulation ◽  
Ecmo Therapy

Removal of extracorporeal membrane oxygenation (ECMO) cannulae and discontinuing systemic anticoagulation typically occurs soon after separation from ECMO. We have found, however, that delaying decannulation after terminating ECMO therapy does not predispose to adverse outcomes and may be advantageous. Between January 2014 and June 2016, 36 postcardiotomy patients at the Children’s Hospital of Oklahoma required ECMO. In this cohort of 36 patients, there was a need for 42 ECMO runs. Of the 42 ECMO runs, 29 (69%) survived to decannulation. Of those ECMO runs that survived to decannulation, 18 (62%) were cannulated centrally and 11 (38%) were cannulated via the neck. For the runs where the patient survived to decannulation, the mean number of days on ECMO support was 4 ± 2 days. There was an average time interval of 21 ± 14 hours from ECMO termination to decannulation. A single patient failed being separated from ECMO support and required reinstitution of ECMO 18 hours after separation (but did not require recannulation).

Characterization of Extracorporeal Membrane Oxygenation Support for Single Ventricle Patients

2020 ◽  
Vol 11 (2) ◽  
pp. 183-191
Author(s):  
Elizabeth H. Stephens ◽  
Aqsa Shakoor ◽  
Shimon E. Jacobs ◽  
Shunpei Okochi ◽  
Ariela L. Zenilman ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Single Ventricle ◽  
Early Recognition ◽  
Orthotopic Heart Transplantation ◽  
Factors Associated ◽  
Membrane Oxygenation ◽  
End Point ◽  
Thrombotic Complications ◽  
Central Cannulation

Background: Extracorporeal membrane oxygenation (ECMO) can provide crucial support for single ventricle (SV) patients at various stages of palliation. However, characterization of the utilization and outcomes of ECMO in these unique patients remains incompletely studied. Methods: We performed a single-center retrospective review of SV patients between 2010 and 2017 who underwent ECMO cannulation with primary end point of survival to discharge and secondary end point of survival to decannulation or orthotopic heart transplantation (OHT). Multivariate analysis was performed for factors predictive of survival to discharge and survival to decannulation. Results: Forty SV patients with a median age of one month (range: 3 days to 15 years) received ECMO support. The incidence of ECMO was 14% for stage I, 3% for stage II, and 4% for stage III. Twenty-seven (68%) patients survived to decannulation, and 21 (53%) patients survived to discharge, with seven survivors to discharge undergoing OHT. Complications included infection (40%), bleeding (40%), thrombosis (33%), and radiographic stroke (45%). Factors associated with survival to decannulation included pre-ECMO lactate (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.41-0.90, P = .013) and post-ECMO bicarbonate (HR: 1.24, 95% CI: 1.0-1.5, P = .018). Factors associated with survival to discharge included central cannulation (HR: 40.0, 95% CI: 3.1-500.0, P = .005) and lack of thrombotic complications (HR: 28.7, 95% CI: 2.1-382.9, P = .011). Conclusions: Extracorporeal membrane oxygenation can be useful to rescue SV patients with approximately half surviving to discharge, although complications are frequent. Early recognition of the role of heart transplant is imperative. Further study is required to identify areas for improvement in this population.

Functional acetabular retroversion syndrome: description of a specific sub-type of FAI and results of treatment with minimally invasive PAO

2019 ◽  
Vol 30 (6) ◽  
pp. 779-786 ◽  
Author(s):  
Michael C Wyatt ◽  
Christian Smith ◽  
Ali Zavareh ◽  
Dominik Pfluger ◽  
Marcus JK Bankes
Keyword(s):  
Minimally Invasive ◽  
Smoking Status ◽  
Periacetabular Osteotomy ◽  
Clinical Results ◽  
Acetabular Retroversion ◽  
Crossover Sign ◽  
Results Of Treatment ◽  
Functional Scores ◽  
The Mean

Introduction: Acetabular retroversion syndrome is associated with pincer-type femoroacetabular impingement (FAI) and results, theoretically, from an externally rotated hemipelvis. The purpose of this study was to examine our surgical experience and the clinical results of functional acetabular retroversion syndrome treated with minimally-invasive periacetabular osteotomy (PAO). Methods: We performed a retrospective cohort study of prospectively collected data in consecutive patients who had an anteverting PAO from 01 November 2010 to 31 December 2015. All patients were followed up clinically and radiologically. Functional scores were ascertained using pre- and postoperative iHOT-12 and EQ-5D. The effect of hypermobility, smoking status and body mass index (BMI) on outcome measures was evaluated. Results: 31 anteverting PAOs were performed on 27 consecutive patients. All patients were female. The mean age was 26.7 years (SD 6.7). The mean BMI was 25.8 kg/m2 (SD 5.1). 5 patients were smokers (16.1%) and 11 exhibited signs of generalised joint laxity. 23 hips had undergone prior hip arthroscopy and 1 patient had previous open FAI surgery. The minimum clinical follow-up was 2 years (mean 3.4 years; range 2–7 years). A crossover sign was present in all cases. The mean iHOT-12 score improved from 19.5 to 51 at 6 months, 64.5 at 1 year and 48 at 2 years following surgery ( p < 0.05) EQ-5D improved from 0.42 preoperatively to 0.76 at 6 months and 0.69 at 1 year following surgery ( p < 0.05). Conclusions: We have characterised functional acetabular retroversion syndrome (FARS) as a condition affecting young, active females which severe symptoms out of proportion to demonstrable radiographic pathology.

Coagulation Profile of Children on Extracorporeal Membrane Oxygenation (ECMO) - Is FXIII the Missing Link?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3795-3795
Author(s):  
Thorsten Haas ◽  
Carsten Doell ◽  
Markus Schmugge ◽  
Melissa M. Cushing ◽  
Vincenzo Cannizzaro
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Factor Xiii ◽  
Massive Transfusion ◽  
Complete Blood Count ◽  
Published Data ◽  
Reference Ranges ◽  
Bleeding Management ◽  
Membrane Oxygenation ◽  
Thrombotic Complications ◽  
The Impact

Abstract Background Published data about bleeding management on extracorporeal membrane oxygenation (ECMO) in children is sparse and to date no global transfusion algorithm has been established. Viscoelastic testing can be effective for determining the etiology and management of coagulopathic bleeding during cardiothoracic procedures, but data regarding its usefulness in ECMO patients are scarce. Recently, low factor XIII levels were determined to be a frequent finding in adult ECMO patients(Kalbhenn et al; Perfusion 2015;30:675-82). Methods This is a retrospective analysis of thromboelastometry (ROTEM®) and factor XIII data obtained in children (ages 0 to 18 years) undergoing ECMO since 2013 in a single center children's hospital. Acute bleeding treatment was based on daily ROTEM testing, complete blood count and routine plasmatic coagulation testing. The transfusion algorithm targeted a hemoglobin level >13g dL-1, a Quick's value >50%, a plasma fibrinogen level >1.5g L-1, and a platelet count of >100,000 µL-1. Red blood cells (RBC), solvent detergent (S/D) plasma and platelet apheresis concentrates were exclusively used to maintain hemostasis. Measurement of FXIII levels is not part of routine testing, but was assessed when unexplained bleeding was observed. Results Laboratory and transfusion data from sixteen patients, age 4 (1-15) months [median(IQR)] with a body weight of 6 (3-8) kg were included. Median time on ECMO was 7 (4-9) days. Large volumes of allogeneic blood were transfused to all children, meeting criteria for massive transfusion each individual day on ECMO (Tab.1). Overall, median daily ROTEM measurements were within reference ranges (Tab.2), while median levels of FXIII were decreased despite massive transfusion [FXIII levels 42% (28-51%)]. Conclusion Pediatric ECMO was almost always combined with daily massive transfusion, which led to correction of overall ROTEM values. Notably, despite transfusion of large amounts of plasma, decreased FXIII levels were noted. This finding is supported by results of a study in adult ECMO patients, where FXIII levels <50% were observed in 88% of all patients. Although inherited homozygous FXIII deficiency is usually defined by levels <5%, even mildly to moderately reduced FXIII levels have been reported to contribute to increased bleeding after cardiac surgery(Ternström et al; Thromb Res 2010;126:e128-33). Further studies should be performed to assess the impact of FXIII substitution in pediatric ECMO patients and to investigate whether substitution of FXIII may decrease bleeding without increasing thrombotic complications. Disclosures Haas: CSL Behring: Speakers Bureau; TEM International: Speakers Bureau; Octapharma: Consultancy.

Evaluation of a pharmacy managed heparin protocol for extracorporeal membrane oxygenation patients

Perfusion ◽  
2016 ◽  
Vol 32 (3) ◽  
pp. 238-244 ◽  
Author(s):  
Kalliopi Fitousis ◽  
Robin Klasek ◽  
Phillip E Mason ◽  
Faisal Masud
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Study Groups ◽  
Similar Rate ◽  
Bleeding Events ◽  
Membrane Oxygenation ◽  
Activated Clotting Time ◽  
Primary Endpoints ◽  
Significant Difference ◽  
Heparin Anticoagulation ◽  
Thrombotic Complications

Introduction: Unfractionated heparin is the preferred anticoagulant in extracorporeal membrane oxygenation (ECMO) patients. However, there is a lack of consensus on its titration and monitoring. The objective of this study was to describe the efficacy and safety of a pharmacy managed heparin protocol utilizing activated partial thromboplastin time (aPTT) in comparison to our standard physician-managed activated clotting time (ACT)-based anticoagulation in ECMO patients. Methods: Patients administered a heparin drip while on ECMO were included in the study. The primary endpoints were the incidence of hemorrhagic and thrombotic complications. Results: A total of 122 adult patients were identified who were on ECMO with heparin anticoagulation; sixty-one patients were managed with each of the physician-managed ACT and pharmacy managed aPTT protocols. No statistically significant difference was observed between the physician ACT and the pharmacy aPTT groups in overall hemorrhagic (69% vs 80%, p=0.145) or thrombotic complications (41% vs 39%, p=0.853). Conclusion: There was a similar rate of thrombotic and bleeding events between the two study groups. A pharmacy managed heparin protocol utilizing aPTT monitoring appears to be a safe and effective method of providing anticoagulation in adult ECMO patients.

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