ABSTRACT
Refractory hypoxemia (RH) during venovenous extracorporeal membrane oxygenation (VV ECMO) support is a complex problem that limits the benefit of this therapy. The need for sustained deep sedation and delays in active rehabilitation are considered as a direct consequence of RH. Changing from VV ECMO to a configuration that returns the flow to pulmonary artery, such as venopulmonary extracorporeal membrane oxygenation (VPa ECMO) may decrease recirculation and improve systemic oxygen delivery. We present a retrospective report that describes the impact of VPa ECMO on oxygenation during sedation withdrawal in 41 patients who received VV ECMO for coronavirus disease 2019 (COVID-19). We evidenced that arterial oxygen pressure (PaO 2 ) increased from 68 to 112.3 mm Hg ( p = 0.001) with a reduction of ECMO flow (5.7-4.8 L/m; p = 0.001). Other findings included lower rates of depth sedation (Richmond Agitation Sedation Scale [RASS] ≤3, 37-63%; p = 0.007) and lower requirement inotropic support assessed by LVIS score (4.7-1.1; p = 0.005). Discharge survival was 54% with a sustained benefit until day 79. This cannulation strategy improved effectively PaO 2 in this cohort, it may be an alternative in patients with RH in VV ECMO.
Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Hypoxia , Humans , Extracorporeal Membrane Oxygenation/methods , Hypoxia/etiology , Hypoxia/therapy , Retrospective Studies , Male , Female , COVID-19/complications , COVID-19/therapy , Middle Aged , Adult , Pulmonary Artery , AgedABSTRACT
Structural heart disease interventions are the transcatheter techniques used for treating non-coronary heart disease. In recent years, these techniques have generated considerable interest even though they still comprise only a small percentage of the total volume of interventions performed in interventional cardiology departments. The level of interest in these techniques is high probably because their application is characterized by a number of special features: a) the need for multidisciplinary teams; b) the need for specialized education and training; c) the requirement for special skills developed through education and experience, and d) the limited number of referral centers at present. This article describes four specific techniques: a) percutaneous closure of perivalvular leaks; b) percutaneous left atrial appendage obliteration; c) percutaneous treatment of mitral regurgitation, and d) transcatheter implantation of prosthetic aortic valves. We explore the rationale for using the technique, the specific procedures involved and the results obtained.
Subject(s)
Cardiology/trends , Heart Diseases/therapy , Aortic Valve Insufficiency/surgery , Cardiac Catheterization , Cardiac Surgical Procedures , Cardiology/education , Catheter Ablation , Clinical Competence , Heart Diseases/surgery , Humans , Mitral Valve Insufficiency/surgery , Patient Care Team , Referral and ConsultationABSTRACT
El intervencionismo estructural se refiere a las técnicas intervencionistas que van dirigidas a enfermedades cardiacas no coronarias. En los últimos años está teniendo un interés muy considerable, aunque todavía representa un porcentaje muy pequeño del volumen total de intervencionismo de un departamento de terapia endovascular. A pesar del pequeño volumen relativo, el interés es muy grande, probablemente debido a las características peculiares que rodean a estas técnicas: a) necesidad de equipos multidisciplinarios; b) formación y entrenamiento específicos; c) requiere habilidades especiales derivadas de la formación y experiencia, y d) escaso volumen en el momento actual que aconseja centros dereferencia. En este capítulo desarrollamos cuatro apartados específicos: a) cierre percutáneo del leak perivalvular (LP);b) obliteración percutánea de la orejuela; c) tratamiento percutáneo de la insuficiencia mitral, y d)implantación transcatéter de prótesis valvulares aórticas. Exploramos las razones de la técnica, los procedimientos específicos y los resultados obtenidos (AU)
Structural heart disease interventions are the transcatheter techniques used for treating non-coronary heart disease. In recent years, these techniques have generated considerable interest even though they still comprise only a small percentage of the total volume of interventions performed in interventional cardiology departments. The level of interest in these techniques is high probably because their application is characterized by a number of special features: a) the need for multidisciplinary teams; b) the need for specialized education and training; c) the requirement for special skills developed through education and experience, and d) the limited number of referral centers at present. This article describes four specific techniques: a) percutaneous closure of perivalvular leaks; b) percutaneous left atrial appendage obliteration;c) percutaneous treatment of mitral regurgitation, and d) transcatheter implantation of prosthetic aorticvalves. We explore the rationale for using the technique, the specific procedures involved and the results obtained (AU)
