RESUMEN
We present a low-cost, simple simulation model of major vascular injury repair for cardiothoracic trainees. This model uses commercially available orthopedic elastic bands to allow repetitive practice of the skills necessary during these rare but critical clinical scenarios. Practicing core skills in the simulation setting will help residents be better prepared when the situation arises.
Asunto(s)
Competencia Clínica , Simulación por Computador , Arteria Pulmonar/cirugía , Entrenamiento Simulado/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Lesiones del Sistema Vascular/cirugía , Humanos , Internado y Residencia/métodos , Arteria Pulmonar/lesiones , Procedimientos Quirúrgicos Vasculares/educaciónRESUMEN
Acute high-risk pulmonary embolism (PE) is characterized by life-threatening hemodynamic instability that may lead to refractory cardiac arrest. Recently, extracorporeal membrane oxygenation (ECMO) has been used to provide primary cardiopulmonary support for select high-risk PE patients or before surgical embolectomy. This article reviews the growing body of literature regarding ECMO support of acute high-risk PE.
Asunto(s)
Enfermedad Aguda/terapia , Embolectomía/normas , Oxigenación por Membrana Extracorpórea/normas , Paro Cardíaco/terapia , Hemodinámica , Guías de Práctica Clínica como Asunto , Embolia Pulmonar/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Embarazo , Mujeres Embarazadas , Embolia Pulmonar/diagnóstico , Factores de Riesgo , Resultado del TratamientoRESUMEN
Venoarterial extracorporeal membrane oxygenation (ECMO) is a rescue therapy that can stabilize patients with hemodynamic compromise, with or without respiratory failure, for days or weeks. In cardiology, the main indications for ECMO include cardiac arrest, cardiogenic shock, post-cardiotomy shock, refractory ventricular tachycardia, and acute management of complications of invasive procedures. The fundamental premise underlying ECMO is that it is a bridge-to recovery, to a more durable bridge, to definitive treatment, or to decision. As a very resource- and effort-intensive intervention, ECMO should not be used on unsalvageable patients. As the use of this technology continues to evolve rapidly, it is important to understand the indications and contraindications; the logistics of ECMO initiation, management, and weaning; the general infrastructure of the program (including the challenges associated with transferring patients supported by ECMO); and ethical considerations, areas of uncertainty, and future directions.