First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation

AUTOR(ES)

Park, Marcelo, Azevedo, Luciano Cesar Pontes, Mendes, Pedro Vitale, Carvalho, Carlos Roberto Ribeiro, Amato, Marcelo Brito Passos, Schettino, Guilherme Paula Pinto, Tucci, Mauro, Maciel, Alexandre Toledo, Taniguchi, Leandro Utino, Barbosa, Edzangela Vasconcelos Santos, Nardi, Raquel Oliveira, Ignácio, Michelle de Nardi, Machtans, Cláudio Cerqueira, Neves, Wellington Alves, Hirota, Adriana Sayuri, Costa, Eduardo Leite Vieira

FONTE

Clinics

DATA DE PUBLICAÇÃO

2012-10

RESUMO

OBJECTIVES: The aim of this manuscript is to describe the first year of our experience using extracorporeal membrane oxygenation support. METHODS: Ten patients with severe refractory hypoxemia, two with associated severe cardiovascular failure, were supported using venous-venous extracorporeal membrane oxygenation (eight patients) or veno-arterial extracorporeal membrane oxygenation (two patients). RESULTS: The median age of the patients was 31 yr (range 14-71 yr). Their median simplified acute physiological score three (SAPS3) was 94 (range 84-118), and they had a median expected mortality of 95% (range 87-99%). Community-acquired pneumonia was the most common diagnosis (50%), followed by P. jiroveci pneumonia in two patients with AIDS (20%). Six patients were transferred from other ICUs during extracorporeal membrane oxygenation support, three of whom were transferred between ICUs within the hospital (30%), two by ambulance (20%) and one by helicopter (10%). Only one patient (10%) was anticoagulated with heparin throughout extracorporeal membrane oxygenation support. Eighty percent of patients required continuous venous-venous hemofiltration. Three patients (30%) developed persistent hypoxemia, which was corrected using higher positive end-expiratory pressure, higher inspired oxygen fractions, recruitment maneuvers, and nitric oxide. The median time on extracorporeal membrane oxygenation support was five (range 3-32) days. The median length of the hospital stay was 31 (range 3-97) days. Four patients (40%) survived to 60 days, and they were free from renal replacement therapy and oxygen support. CONCLUSIONS: The use of extracorporeal membrane oxygenation support in severely ill patients is possible in the presence of a structured team. Efforts must be made to recognize the necessity of extracorporeal respiratory support at an early stage and to prompt activation of the extracorporeal membrane oxygenation team.

Documentos Relacionados

• A two-year experience teaching computer literacy to first-year medical students using skill-based cohorts
• Characteristics of first-year students in Canadian medical schools
• Faculty involvement in problem-based library orientation for first-year medical students.
• First-year students’ perceptions of team-based learning in a new medical genetics course
• Attitudes of First-year Medical Students Toward the Confidentiality of Computerized Patient Records