RESUMO
We describe seven critically ill and seven noncritically ill patients with coronavirus disease 2019 infection. Two viscoelastic assays were performed with ClotPro technology, activated by extrinsic system test and recombinant tissue plasminogen activator challenge test. Coagulation profile presents a marked hypercoagulability with increased resistance to fibrinolysis, reflected by tissue plasminogen activator test. Our pathological observations show that the hypercoagulative status described in these patients is, at least partially, secondary to fibrinolysis shutdown.
Assuntos
COVID-19/sangue , Fibrinólise , SARS-CoV-2 , Trombofilia/etiologia , Adulto , Idoso , Contagem de Células Sanguíneas , Testes de Coagulação Sanguínea , COVID-19/complicações , Comorbidade , Estado Terminal , Progressão da Doença , Feminino , Hemorragia/epidemiologia , Hemorragia/etiologia , Mortalidade Hospitalar , Hospitais Urbanos , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Quartos de Pacientes , Proteínas Recombinantes , Espanha/epidemiologia , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Trombofilia/sangue , Ativador de Plasminogênio TecidualRESUMO
Prone position is necessary for some neurosurgical and othopedic procedures. Cardiopulmonary resuscitation (CPR) in prone position was first described by McNeil in 1989, since then several successful cases have been published. We report the case of a 72-year-old patient with history of stage IV breast cancer who presented acute spinal cord compression due to a vertebral fracture at T10 level. Surgical spinal cord decompression and posterior arthrodesis was performed. After three hours of surgery, cardiorespiratory arrest occur while patient was in prone position. Unestable spine and fixed head made turning the patient into supine position very difficult, consequently prone CPR manoeuvres were started with recovery of spontaneous circulation. In case of cardiorespiratory arrest in prone position, the intense fixation and the extent of the surgical incision make the change to supine a time-consuming and technically complex procedure. If cardiorespiratory arrest occurs in the prone position, CPR in the prone position might be reasonable.
La posición de decúbito prono es necesaria para la realización de algunos procedimientos neuroquirúrgicos y traumatológicos. La reanimación cardiopulmonar (RCP) en prono fue descrita por primera vez por McNeil en 1989, desde entonces se han publicado varios casos de RCP en prono con buen resultado. Presentamos el caso de una paciente de 72 años con antecedentes de carcinoma de mama estadio IV que presenta síndrome de compresión medular por fractura patológica a nivel de T10. Se decide realizar descompresión medular y artrodesis por vía posterior. A las 3 horas de la cirugía se produjo parada cardiorrespiratoria en prono. Dada la inestabilidad espinal y la fijación de la paciente, el cambio a supino era complejo por lo que se iniciaron maniobras de RCP en prono con posterior recuperación de circulación espontánea. En caso de parda cardiorrespiratoria en prono, la intensa fijación y la extensión de la incisión quirúrgica hace que el cambio a supino consuma tiempo y sea técnicamente complejo. Si la PCR ocurre en prono, está justificado iniciar las maniobras de RCP en esta posición.
