[Interhospital transport of patients requiring extracorporeal membrane oxygenation ECMO]. / Transport chorych z zastosowaniem utleniania pozaustrojowego (ECMO).

BACKGROUND: The recent outbreak of AH1N1 influenza was associated with an increased number of respiratory complications. There were some extremely severe cases of ARDS, in which conventional therapy could not secure adequate gas exchange. These patients fulfilled ECMO criteria, however, due to late referral, were not suitable for transportation. To solve this problem, a portable ECMO system, providing for safe management of these patients, has been introduced in our institution. CASE REPORT: We reviewed five adult ARDS patients, who were transported by an ambulance for a distance ranging from 2 to 95 km, over 35 to 120 min. In four cases, a veno-venous ECMO system was used, and one patient had an arterio-venous circuit. All circuits were implanted before transportation by a dedicated team from the reference hospital, comprising an anaesthesiologist, a cardiac surgeon and a perfusionist. All transportations were successful and no complications and/or technical problems were observed. During the subsequent ITU treatment, three patients survived and two died (one because of uncontrollable bleeding from the ECMO cannula, and one because of sepsis and multiple organ failure). CONCLUSION: We conclude that safe use of ECMO during transportation is possible, and does not require very sophisticated and expensive equipment. A standard ambulance is sufficient for the purpose.

[The use of extracorporeal membrane oxygenation (ECMO) in the treatment of acute respiratory distress syndrome due to pandemic influenza]. / Zastosowanie utleniania pozaustrojowego (ECMO) w leczeniu ostrej niewydolnosci oddechowej wywolanej infekcja wirusem grypy pandemicznej.

Pandemic influenza particularly often is associated with symptoms of acute respiratory failure, and in case of refractory hypoxemia patients may have indications for the extracorporeal membrane oxygenation (ECMO). The paper presents a case of a pandemic influenza virus infection, where classical indications for veno-venous ECMO occured. Practical aspects of this kind of treatment in the intensive care unit are discussed.

[Acute renal failure as a complication of cardiac surgery]. / Ostra niewydolnosc nerek wymagajaca terapii nerkozastepczej jako powiklanie operacji serca.

We observed acute, postoperative renal failure requiring dialysis in 33 patients from the entire group of adult patients who received cardiac surgery in 2004 in The Silesian Center for Heart Diseases in Zabrze. Over 50% of these were qualified for emergency operation. During the early postoperative period all of the examined patients had cardiac failure and circulatory insufficiency requiring high doses of catecholamine and intraaortic balloon pump support. In the analyzed group of patients the frequency of multi-organ failure was high (neurologic dysfunction, the need for prolonged mechanical ventilation, mesenteric ischemia). Hemodiafiltration was used as a renal replacement therapy with the dialisate volume not exceeding 11/h. The volume of ultrafiltrate was regulated on the basis of fluid overload and directed to optimize intravascular filling. The average start of hemofiltration was the 3rd postoperative day and was continued for 5 days. The mortality rate in the analyzed group was 81.8%. The renal function substitution based on hemodiafiltration performed in the way described above is easy to start, easy to manage, generates low costs, nevertheless its efficacy is low.

[Newborn life threatening respiratory failure treatment with extracorporeal membrane oxygenation]. / Leczenie skrajnej niewydolnosci oddechowej noworodków z zastosowaniem natleniania pozaustrojowego.

UNLABELLED: THE AIM of the study was to show first results of newborn life threatening respiratory failure treatment with extracorporeal membrane oxygenation (ECMO) in Poland. MATERIAL: Nine newborns were treated with extracorporeal membrane oxygenation in Silesian Center for Heart Diseases. Newborns were born in 38 week of gestational age (36-41 weeks) with mean birth weight of 3490 g. Reasons for the referral were: meconium aspiration syndrome, infection, and pulmonary hypertension. Each newborn fulfilled an Extracorporeal Life Support Organization (ELSO) criteria for extracorporeal membrane oxygenation. RESULTS: seven out of nine of patients treated with extracorporeal membrane oxygenation survived. Full clinical stabilization was reached about 6th hour of treatment. Mean extracorporeal oxygenation time was 162 hours. For eight newborns veno-venous method was applied and for one newborn veno-arterial method. Roller pump was used in 7 cases and centrifugal pomp in one case. Five newborns had uneventful treatment. During extracorporeal membrane oxygenation therapy we have observed several complications: PDA, hemorrhagic complications, renal failure, arterial hypertension, septicemia, tubing rupture. CONCLUSIONS: extracorporeal oxygenation is an effective method of treatment for newborn life threatening respiratory failure. Obtained results do not differ much from Extracorporeal Life Support Organization register results. The most essential problem for extracorporeal membrane oxygenation therapy is correct qualification, early referral, safe transportation as well as the development of centers providing ECMO treatment.