Extracorporeal membrane oxygenation in adult patients with severe acute respiratory failure.

BACKGROUND: A group of patients with severe acute respiratory distress syndrome (ARDS) is resistant to advanced respiratory therapy. In these patients, extracorporeal membrane oxygenation (ECMO) can be used as a rescue therapy. This study presents 14 years of experience from a Scandinavian ECMO centre. The aim of the study is to present outcome results and to investigate whether or not simplified acute physiology score II (SAPS-II), sequential organ failure assessment (SOFA) and/or Murray scores can be used to predict patients' outcome. METHODS: In a prospective observational study, we collected data from ECMO patients from January 1997 to March 2011. The treatment was based mainly on venous-venous ECMO and centrifugal pumps. Patients were retrieved from Denmark plus a number from Sweden and Norway. The inclusion criteria were the classical criteria until November 2009 (n = 100), after which the new Extracorporeal Life Support Organisation criteria (n = 24) were used. RESULTS: One hundred and twenty-four patients were enrolled with median age 45 (range 16-67) years. The median Murray score was 3.7 (2.5-4.0). One hundred and six (85%) of the patients were retrieved from referring hospitals on ECMO. The median duration of the ECMO runs was 215 (1-578) h. Ninety-seven (78%) of the patients could be weaned from ECMO. A total of 88 (71%) were discharged alive to the referring hospitals. High SAPS-II, SOFA and Murray scores were associated with a high mortality. CONCLUSION: Patients with severe ARDS have a favourable outcome when treated with ECMO and when an ECMO retrieval team establishes the ECMO treatment at the referring hospital. SAPS-II, SOFA and Murray scores predicted the outcome.

[Ambulatory knee arthroscopy in arthroscopic surgery under local anesthesia]. / Ambulant knaeartroskopi med artroskopisk kirurgi i lokalanaestesi.

After introducing knee arthroscopy in local anaesthesia as a standard regime in outpatients, we want to describe our experiences from 403 arthroscopies performed in 401 patients, aged 15-80 years, mean 37 years. Diagnostic arthroscopy was performed successfully in 397 of 403 cases. Arthroscopic surgery was indicated in 203 patients and carried out in 188 cases. It was possible to resect 144 of 158 tears of the meniscus. In conclusion, outpatient arthroscopy of the knee with transarthroscopic surgery in local anaesthesia using high dose lidocaine and no sedation is a valuable tool, and should be used on a larger scale. It is possible to carry out diagnostic arthroscopy and arthroscopic surgery in most patients, especially concerning resections of menisci.