Recomendaciones de manejo de pacientes con asistencia circulatoria mecánica de corta duración / Recommendations for the management of patients with short-term mechanical circulatory assistance

There has been a progressive increase in the use of mechanical circulatory support in our country in the last years, mainly in the short-term: as a bridge to cardiac transplant or recovery, which has allowed to rescue patients from a population that concentrates high rates of complications and mortality. This motivated that the Ministry of Health convened a series of experts in the area of heart failure, transplantation and mechanical circulatory support, representatives of different public and private health centers in Chile, with the objective of developing recommendations on the use of short-term mechanical assistance devices, which would serve as a reference for the proper management of these patients. This clinical experts consensus document contains topics related to: definitions and general concepts; indications; contraindications; specific aspects of starting, follow-up and weaning of the devices; process of transfer of patients in circulatory assistance from one center to another and finally criteria of organization, means and competences to be fulfilled by the centers that offer this therapeutic option.

Nursing care protocol for patients with a ventricular assist device / Protocolo de atención de enfermería a pacientes con dispositivo de asistencia ventricular / Protocolo de cuidados de enfermagem a pacientes com dispositivo de assistência ventricular

ABSTRACT Objective: to develop and validate a nursing care protocol for patients with a ventricular assist device (VAD). Method: descriptive study, with a quantitative approach, for an instrument's methodological validation. Three stages were conducted: development of the instrument; protocol content validation according to the Delphi technique, and agreement among experts and the scientific literature. Results: based on the content validation, a care protocol for patients with a VAD was created and assessed by Spanish experts. Of the 15 items evaluated by means of the content validity index (CVI), 10 presented solid evidence of validation, with Kappa ranging between 0.87 and 1. Conclusion: the method enabled the validation of interventions that will contribute to qualified and standardized care for patients with a VAD.

RESUMEN Objetivo: elaborar y validar un protocolo de atención de enfermería a pacientes con dispositivo de asistencia ventricular (DAV). Método: estudio descriptivo, con abordaje cuantitativo, de validación metodológica de instrumento. Se siguieron tres etapas: elaboración del instrumento; validación del contenido del protocolo según técnica de Delphi y concordancia entre expertos y la literatura científica. Resultados: en base a la validación del contenido, se elaboró un protocolo referido a la atención de pacientes en uso de DAV, evaluado por expertos/jueces españoles. De los 15 ítems evaluados, mediante el índice de Validez de Contenido (IVC), 10 de ellos presentaron fuerte evidencia de validación con Kappa, variando entre 0,87 y 1. Conclusión: el método permitió validar intervenciones que contribuirán a una atención calificada y uniforme a pacientes en uso de DAV.

RESUMO Objetivo: elaborar e validar um protocolo de cuidados de enfermagem a pacientes com dispositivo de assistência ventricular (DAV). Método: estudo descritivo, com abordagem quantitativa de validação metodológica de instrumento. Seguiram-se três etapas: elaboração do instrumento; validação do conteúdo do protocolo segundo a técnica de Delphi e concordância entre peritos e a literatura científica. Resultados: com base na validação do conteúdo, elaborou-se um protocolo referente aos cuidados a paciente em uso de DAV avaliado por peritos/juízes espanhóis. Dos 15 itens avaliados, por meio do Índice de Validade de Conteúdo (IVC), 10 deles apresentaram forte evidência de validação com Kappa que variaram de 0,87 a 1. Conclusão: o método permitiu validar intervenções que contribuirão para um cuidado qualificado e uniformizado a pacientes em uso de DAV.

Clinical evaluation of the Spiral Pump® after improvements to the original project in patients submitted to cardiac surgeries with cardiopulmonary bypass / Avaliação clínica da bomba espiral (Spiral Pump®) após aperfeiçoamentos introduzidos ao projeto original em pacientes submetidos a cirurgias cardíacas com circulação extracorpórea

Objective: The objective of this paper is to present the results from Spiral Pump clinical trial after design modifications performed at its previous project. This pump applies axial end centrifugal hydraulic effects for blood pumping during cardiopulmonary bypass for patients under cardiac surgery. Methods: This study was performed in 52 patients (51% males), between 20 to 80 (67±14.4) years old weighing 53 to 102 (71.7±12.6) kg, mostly under myocardial revascularization surgery (34.6%) and valvular surgery (32.8%). Besides the routine evaluation of the data observed in these cases, we monitored pump rotational speed, blood flow, cardiopulmonary bypass duration, urine free hemoglobin for blood cell trauma analysis (+ to 4+), lactate desidrogenase (UI/L), fibrinogen level (mg/dL) and platelet count (nº/mm3). Results: Besides maintaining appropriate blood pressure and metabolic parameters it was also observed that the Free Hemoglobin levels remained normal, with a slight increase after 90 minutes of cardiopulmonary bypass. The Lactate Dehydrogenase showed an increase, with medians varying between 550-770 IU/L, whereas the decrease in Fibrinogen showed medians of 130-100 mg/dl. The number of platelets showed a slight decrease with the medians ranging from 240,000 to 200,000/mm3. No difficulty was observed during perfusion terminations, nor were there any immediate deaths, and all patients except one, were discharged in good condition. CONCLUSION: The Spiral Pump, as blood propeller during cardiopulmonary bypass, demonstrated to be reliable and safe, comprising in a good option as original and national product for this kind of application. .

Objetivos: Apresentar resultados da aplicação da bomba espiral que emprega efeitos hidráulicos centrífugo e axial de bombeamento como elemento propulsor do circuito de circulação extracorpórea em pacientes submetidos a cirurgias cardíacas após modificações introduzidas no design do projeto original. Métodos: O estudo foi realizado em 52 pacientes (51% masculinos), com idade entre 20 a 80 (67±14,4) anos, peso 53 a 102 (71,7±12,6) kg, submetidos na maioria a cirurgia de revascularização miocárdica (34,6%) e Orovalvar (32,8%). Além das avaliações rotineiras, foram registrados rotação, tempo de CEC e para análise do impacto traumático à crase sanguínea, hemoglobina livre na urina (+ a 4+), desidrogenase láctica, fibrinogênio (mg/dL) e contagem de plaquetas (nº/mm3). Resultados: Observou-se a manutenção de parâmetros pressóricos e metabólicos adequados. Quanto aos marcadores de danos à crase sanguínea, as alterações estiveram proporcionais ao tempo maior de circulação extracorpórea. Os níveis de Hemoglobina Livre permaneceram com valores normais, com ligeiro aumento a partir dos 90 minutos de circulação extracorpórea. A Desidrogenase Láctica mostrou aumento, variando as medianas entre 550 a 770 UI/L enquanto o Fibrinogênio mostrou queda das medianas de 130 a 100 mg/dl. O número de plaquetas mostrou ligeira queda das medianas variando entre 240.000 a 200.000/mm3. Não ocorreram dificuldades de saída de perfusão, não se observou óbito imediato e todos os pacientes, exceto 1, obtiveram alta hospitalar. Conclusão: A bomba espiral aplicada como bomba propulsora de sangue durante cirurgia cardíaca se mostrou confiável e segura, não causou impacto traumático ...

Puente al trasplante de 4 semanas utilizando el sistema de asistencia ventricular Levitronix Centrimag® en el shock cardiogénico post-infarto al miocardio: Caso clínico / Four-week Levitronix Centrimag® bridge-to-transplant for post myocardial infarction cardiogenic shock: A case report

Cardiogenic shock after myocardial infarction has a high mortality even if early revascularization is achieved. Biventricular assist devices have not been used in Chile in this critical setting. We report a case of a 55 year-old diabetic man who suffered an acute chest pain and ventricular fibrillation. Prompt outside hospital defibrillation/ reanimation restored pulse and allowed emergency room transfer on mechanical ventilation. Electrocardiogram showed an anterior myocardial infarction and early revascularization was achieved by anterior descending artery angioplasty. However, severe cardiogenic shock continued in spite of inotropic and intra aortic balloon pump support. Levitronix Centrimag® biventricular mechanical circulatory support was inserted during reanimation for recurrent ventricular fibrillation and the patient listed for urgent cardiac transplantation upon stabilization. Heart transplantation was performed successfully 28 days later and the patient was discharged after a 21-day recovery period. Twelve months after transplant the patient is in NYHA functional class I with normal biventricular function. Levitronix Centrimag® biventricular mechanical circulatory support could be used successfully as a bridge-to-transplant for myocardial infarction cardiogenic shock.

Estado actual de los sistemas de soporte circulatorio mecánico: State of the art / Circulatory mechanical support. State of the art

Despite advances in medical treatment, the prognosis of advanced heart failure remains poor. The number of hospitalizations for heart failure exacerbations continues to increase and most patients will ultimately die of complications related to heart failure. Implantable left ventricular assist devices (LVAD) are currently in use throughout the world with increasing frequency. This paper is a comprehensive review about mechanical support, focusing on a general description of the differents LVAD, complications and mortality.

Utilización de la Bio-Pump en el tratamiento quirúrgico del aneurisma de aorta tipo "B" / Use of Bio-Pump in surgical treatment of aortic aneurysm type \"B\"

Entre agosto de 1989 y octubre de 1990, se operaron 5 pacientes portadores de aneurismas disecante crónico de la aorta descendente (ADCAD), en los que se usó una derivación arterio-arterial con interposición de una bomba centrífuga durante la oclusión aórtica. Población. Sexo masculino: n=4, femenino: n=1, edad media 58,2 años (44-67). Diagnóstico positivo por clínica, tomografía y angiografía de ADCAD tipo B de Stanford. En todos los casos se abordó por toracotomía posterolateral izquierda, cuarto espacio intercostal. Se realizó canulación cayado aórtico-femoral n=4 y aurícula izquierda-femoral n=1, con interposición de una bomba centrífuga que mantuvo un flujo aproximado de 2.000 cc/min durante la oclusión aórtica. Tiempo de clampeo aórtico media 45,6' (30-78). No se requirió heparinización. Se usó una técnica de autotransfusión. Los procedimientos fueron: resección e injerto con prótesis tubular: 3, aortoplastía: 1, endoneurismorrafía: 1. No hubo complicaciones ni mortalidad hospitalaria. El tiempo de internación fue de n=5: media 11,6 días (9-12). Se concluye que la autorregulación del sistema, con disminución de post-carga del ventrículo izquierdo, permite un fácil manejo hemodinámico durante el procedimiento. La ausencia de heparinización facilita una correcta hemostasia. Estas ventajas contribuyeron en éste número limitado de casos a obtener ausencia de morbimortalidad con un corto período de hospitalización