Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.225
Filtrar
2.
Medicine (Baltimore) ; 99(11): e19488, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176086

RESUMO

INTRODUCTION: Dyspnea due to tracheal invasion by malignant tumors is a common oncological emergency that is difficult to manage, and a common cause of death among patients with advanced cancer. Bronchoscopy-guided intervention therapy under conventional ventilation is very risky for patients with severe central airway stenosis. Extracorporeal membrane oxygenation (ECMO) provides strong cardiopulmonary support, but is rarely used in bronchoscopy-guided interventional therapy. PATIENT CONCERNS: The patient had advanced esophageal cancer with metastases to the trachea and left and right main bronchi. Despite several sessions of radiotherapy, chemotherapy, and bronchoscopy-guided intervention therapy, the tumor in the airway became enlarged, the lumen was severely narrow, and the patient experienced respiratory distress. DIAGNOSIS: A thoracic computed tomography scan performed at our hospital revealed invasion of the trachea and opening of the left and right main bronchi by the esophageal cancer, blockage of the stent by the tumor, and severe luminal narrowing. An emergency bronchoscopy showed slit-like stenosis of the middle and lower part of the trachea and the left and right main bronchi, and the tumor was highly vascular. INTERVENTIONS: To reduce the risk of major airway bleeding and asphyxia during bronchoscopy under conventional ventilation, we finally performed argon plasma coagulation with a high frequency electric knife and cryotherapy with ECMO support. OUTCOMES: We successfully cleared the tumor tissue in the airway under ECMO support. The trachea and left and right main bronchi recovered smoothly, and the patient was soon discharged. CONCLUSION: ECMO can meet the oxygenation needs during bronchoscopy-guided intervention therapy. For patients with severe central airway obstruction due to malignant tumors, ECMO should be considered if conventional respiratory support cannot guarantee the safety of surgery.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias da Traqueia/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Broncoscopia , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Diagnóstico Diferencial , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Oxigenação por Membrana Extracorpórea , Fazendeiros , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Tomografia Computadorizada por Raios X , Neoplasias da Traqueia/complicações , Neoplasias da Traqueia/secundário , Neoplasias da Traqueia/cirurgia
3.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(3): 195-198, 2020 Mar 12.
Artigo em Chinês | MEDLINE | ID: mdl-32164087

RESUMO

Along with the sharp increase of confirmed cases novel coronavirus infection, more critically ill cases require extracorporeal membrane oxygenation (ECMO) support. Based on the clinical data of novel coronavirus pneumonia (NCP), as well as the dada from previous clinical studies and the recommendations from the Extracorporeal Life Support Organization (ELSO), the committee board of the Chinese Society of Extracorporeal Life Support (CSECLS) made this recommendations to guide clinical ECMO application in the patients with NCP.


Assuntos
Infecções por Coronavirus/complicações , Estado Terminal/terapia , Oxigenação por Membrana Extracorpórea/métodos , Pneumonia Viral/terapia , Humanos , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto
5.
Crit Care Resusc ; 22(1): 26-34, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32102640

RESUMO

BACKGROUND: Patients with prolonged cardiac arrest that is not responsive to conventional cardiopulmonary resuscitation have poor outcomes. The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest has shown promising results in carefully selected cases. We sought to validate the results from an earlier extracorporeal cardiopulmonary resuscitation (ECPR) study (the CHEER trial). METHODS: Prospective, consecutive patients with refractory in-hospital (IHCA) or out-of-hospital cardiac arrest (OHCA) who met predefined inclusion criteria received protocolised care, including mechanical cardiopulmonary resuscitation, initiation of ECMO, and early coronary angiography (if an acute coronary syndrome was suspected). RESULTS: Twenty-five patients were enrolled in the study (11 OHCA, 14 IHCA); the median age was 57 years (interquartile range [IQR], 39-65 years), and 17 patients (68%) were male. ECMO was established in all patients, with a median time from arrest to ECMO support of 57 minutes (IQR, 38-73 min). Percutaneous coronary intervention was performed on 18 patients (72%). The median duration of ECMO support was 52 hours (IQR, 24-108 h). Survival to hospital discharge with favourable neurological recovery occurred in 11/25 patients (44%, of which 72% had IHCA and 27% had OHCA). When adjusting for lactate, arrest to ECMO flow time was predictive of survival (odds ratio, 0.904; P = 0.035). CONCLUSION: ECMO for refractory cardiac arrest shows promising survival rates if protocolised care is applied in conjunction with predefined selection criteria.


Assuntos
Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/terapia , Reperfusão Miocárdica , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Reanimação Cardiopulmonar/mortalidade , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Parada Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(5): e19070, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000456

RESUMO

RATIONALE: Extracorporeal membrane oxygenation (ECMO) in multiple trauma patients with post-traumatic respiratory failure can be quite challenging because of the need for systemic anticoagulation, which may lead to excessive bleeding. In the last decade, there is a growing body of evidence that veno-venous ECMO (VV-ECMO) is lifesaving in multiple trauma patients with acute respiratory distress syndrome, thanks to technical improvements in ECMO devices. PATIENT CONCERNS: We report a case of a 17-year-old multiple trauma patient who was drunken and had confused mentality. DIAGNOSES: She was suffered from critical respiratory failure (life-threatening hypoxemia and severe hypercapnia/acidosis lasting for 70 minutes) accompanied by cardiac arrest and trauma-induced coagulopathy during general anesthesia. INTERVENTIONS: We decided to start heparin-free VV-ECMO after cardiac arrest considering risk of hemorrhage. OUTCOMES: She survived with no neurologic sequelae after immediate treatment with heparin-free VV-ECMO. LESSONS: Heparin-free VV-ECMO can be used as a resuscitative therapy in multiple trauma patients with critical respiratory failure accompanied by coagulopathy. Even in cases in which life-threatening hypoxemia and severe hypercapnia/acidosis last for >1 hours during CPR for cardiac arrest, VV-ECMO could be considered a potential lifesaving treatment.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Traumatismo Múltiplo/terapia , Adolescente , Transtornos da Coagulação Sanguínea/terapia , Feminino , Parada Cardíaca/terapia , Humanos , Síndrome do Desconforto Respiratório do Adulto/terapia
8.
Pneumologie ; 74(1): 46-49, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31958870

RESUMO

In 2017 the German Clinical Guideline for Treating Acute Respiratory Insufficiency with Invasive Ventilation and Extracorporeal Membrane Oxygenation: Evidence-Based Recommendations were released. This article highlights emerging data and new concepts which were introduced since 2017. Among others it summarizes the current progress made in evidence-based recommendations of mechanical ventilation and extracorporeal membrane oxygenation (ECMO). In detail, the new evidence for treating severe ARDS with ECMO, phenotyping of ARDS, early neuromuscular blockade and the application of non-invasive ventilation and high-flow oxygen therapy are discussed.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Guias de Prática Clínica como Assunto , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Insuficiência Respiratória/diagnóstico , Doença Aguda , Humanos , Pulmão , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Insuficiência Respiratória/fisiopatologia
9.
Medicine (Baltimore) ; 99(2): e18658, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914051

RESUMO

RATIONALE: Despite increasing number of left ventricular assist device (LVAD) implantation, standardized cardiopulmonary resuscitation (CPR) protocol for patients with LVAD, especially in out-of-hospital settings are not well known. PATIENT CONCERNS: A 41-year-old LVAD implanted man became cardiac arrest in an out-of-hospital setting. Bystander CPR was started and the patient was brought to our hospital without noticing LVAD. Upon arrival, the medical staff noted the LVAD and that the battery of the LVAD was exhausted. DIAGNOSIS: Cardiac arrest on LVAD. INTERVENTIONS: It took 50 minutes to change the battery, then the patient has become ventricular fibrillation; hence, we introduced extracorporeal membranous oxygenation and defibrillated the patient. After the sinus rhythm was restored, the LVAD started working uneventfully. OUTCOMES: The patient became brain dead. LESSONS: There are several difficulties in treating these patients. First, hemodynamic collapse is difficult to diagnose. Second, chest compression for LVAD implanted patients remains controversial. Third, education to first responders who are not familiar with LVAD are not enough. Appropriate education for those issues is needed.


Assuntos
Reanimação Cardiopulmonar/métodos , Coração Auxiliar , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Cardioversão Elétrica , Fontes de Energia Elétrica , Oxigenação por Membrana Extracorpórea , Humanos , Masculino , Parada Cardíaca Extra-Hospitalar/complicações , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia
10.
PLoS One ; 15(1): e0224931, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31999712

RESUMO

The plasticizer di(2-ethylhexyl)phthalate (DEHP) is often used for PVC medical devices, that are also largely used for intensive care medical treatments, like extracorporeal membrane oxygenation (ECMO) therapy. Due to the toxicological potential of DEHP, the inner exposure of patients with this plasticizer is a strong matter of concern as many studies have shown a high leaching potential of DEHP into blood. In this study, the inner DEHP exposure of patients undergoing ECMO treatment was investigated. The determined DEHP blood levels of ECMO patients and the patients of the control group ranged from 31.5 to 1009 µg/L (median 156.0 µg/L) and from 19.4 to 75.3 µg/L (median 36.4 µg/L), respectively. MEHP blood levels were determined to range from < LOD to 475 µg/L (median 15.9 µg/L) in ECMO patients and from < LOD to 9.9 µg/L (median 3.7 µg/L) in the control group patients, respectively. Increased DEHP exposure was associated with the number of cannulas and membranes of the ECMO setting, whereas residual diuresis decreased the exposure. Due to the suspected toxicological potential of DEHP, its use in medical devices should be further investigated, in particular for ICU patients with long-term exposure to PVC, like in ECMO therapy.


Assuntos
Dietilexilftalato/sangue , Monitoramento Ambiental , Oxigenação por Membrana Extracorpórea/efeitos adversos , Plastificantes/efeitos adversos , Idoso , Cuidados Críticos , Dietilexilftalato/efeitos adversos , Dietilexilftalato/análogos & derivados , Dietilexilftalato/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Plastificantes/uso terapêutico , Cloreto de Polivinila/efeitos adversos , Cloreto de Polivinila/uso terapêutico
11.
J Cardiothorac Surg ; 15(1): 16, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931854

RESUMO

BACKGROUND: We have previously reported our outcome after extra-corporeal membrane oxygenation as bridge-to-lung transplantation, which initially was considered controversial, but over time have gained acceptance and now is performed in most high-volume institutions. CASE PRESENTATION: We now report two "extreme" extra-corporeal membrane oxygenation (ECMO) bridge-to-lung transplantation cases, on ECMO > 200 days prior to lung transplantation. One patient survived long-term and the other one did not, and clinical cause and morbidity is outlined in this case-report. CONCLUSION: We believe these two cases highlight the medical, ethical and resource allocation difficulties involved with saving patients in very dire circumstances. We have shown that a patient can survive extremely long duration of ECMO bridge to lung transplantation, but selection remains crucial to achieve a reasonable cost-benefit.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Transplante de Pulmão , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
12.
Int Heart J ; 61(1): 89-95, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31956149

RESUMO

Thrombocytopenia is a frequent complication in patients requiring intra-aortic balloon pumping (IABP) counterpulsation. However, its prognostic impact has not been fully addressed. The objective of this study is to evaluate the impact of the change in the platelet number during IABP use on the prognosis after device removal.This is a retrospective observational study. Patients in the intensive cardiac care unit at three Juntendo University hospitals who underwent percutaneous implantation of IABP with or without veno-arterial extracorporeal membrane oxygenation (V-A ECMO), since 2012-2016, were enrolled in the study (n = 439). Patients who died during mechanical circulatory support (n = 47) were excluded. We evaluated the prognostic impact of the ratio of platelet reduction from the baseline (% PLT reduction) during IABP use on cardiovascular mortality after device removal.The median and the range of follow-up period were 298 days and 0-1,869 days, respectively. Unadjusted Kaplan-Meier analysis demonstrated that patients with a higher % PLT reduction had higher cardiovascular (CV) mortality. An adjusted Cox proportional hazard analysis demonstrated that a 10% higher % PLT reduction was associated with higher cardiovascular (CV) mortality (Hazard ratio: 1.3, 95% Confidence interval: 1.1-1.6, P < 0.001). Moreover, % PLT reduction and the maximum C-reactive protein (CRP) level during IABP use were positively correlated (r = 0.326, P < 0.001).The reduced number of platelets during IABP use was associated with an increased risk of CV mortality.


Assuntos
Remoção de Dispositivo/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Balão Intra-Aórtico/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo/mortalidade , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Humanos , Unidades de Terapia Intensiva , Balão Intra-Aórtico/mortalidade , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
13.
Curr Opin Anaesthesiol ; 33(1): 43-49, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31688086

RESUMO

PURPOSE OF REVIEW: Recent literature has described the emerging role of anesthesiologists as key members of the lung transplantation team and the impact of anesthetic management on outcomes. This review examines the impact of presenting cause of end-stage lung disease (ESLD) on anesthetic management. RECENT FINDINGS: The four primary causes of ESLD are suppurative, obstructive, or restrictive processes, and pulmonary hypertension. Our recent review of perioperative literature revealed new data regarding preoperative risk stratification, intraoperative management, and postoperative use of extracorporeal membrane oxygenation (ECMO) support. Major studies specifically about anesthetic management are lacking; however, the principles studied are readily applicable to the design of a perioperative care plan. The most compelling data have resulted in a revolutionary change in terms of intraoperative support and postoperative planning for pulmonary hypertension patients. Historically treated with cardiopulmonary bypass, significant data have been reported describing the successful use of ECMO both as an intraoperative support with superior outcomes, as well as postoperative support for improved stability during biventricular remodeling post graft implantation. SUMMARY: The application of these updated findings should assist anesthesiologists as they develop internal protocols and external guidelines to integrate within multidisciplinary teams caring for the lung transplant patient.


Assuntos
Anestesia Geral , Anestésicos , Oxigenação por Membrana Extracorpórea , Transplante de Pulmão , Anestesia Geral/métodos , Humanos , Estudos Retrospectivos , Resultado do Tratamento
14.
Curr Opin Anaesthesiol ; 33(1): 71-82, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31764007

RESUMO

PURPOSE OF REVIEW: The aims of this review are to discuss the impact of extracorporeal membrane oxygenation (ECMO) on antibiotic pharmacokinetics and how this phenomenon may influence antibiotic dosing requirements in critically ill adult ECMO patients. RECENT FINDINGS: The body of literature describing antibiotic pharmacokinetic and dosing requirements during ECMO support in critically adult patients is currently scarce. However, significant development has recently been made in this research area and more clinical pharmacokinetic data have emerged to inform antibiotic dosing in these patients. Essentially, these clinical data highlight several important points that clinicians need to consider when dosing antibiotics in critically ill adult patients receiving ECMO: physicochemical properties of antibiotics can influence the degree of drug loss/sequestration in the ECMO circuit; earlier pharmacokinetic data, which were largely derived from the neonatal and paediatric population, are certainly useful but cannot be extrapolated to the critically ill adult population; modern ECMO circuitry has minimal adsorption and impact on the pharmacokinetics of most antibiotics; and pharmacokinetic changes in ECMO patients are more reflective of critical illness rather than the ECMO therapy itself. SUMMARY: An advanced understanding of the pharmacokinetic alterations in critically ill patients receiving ECMO is essential to provide optimal antibiotic dosing in these complex patients pending robust dosing guidelines. Antibiotic dosing in this patient population should generally align with the recommended dosing strategies for critically ill patients not on ECMO support. Performing therapeutic drug monitoring (TDM) to guide antibiotic dosing in this patient population appears useful.


Assuntos
Antibacterianos , Oxigenação por Membrana Extracorpórea , Adulto , Antibacterianos/uso terapêutico , Criança , Estado Terminal , Humanos
15.
Curr Opin Anaesthesiol ; 33(1): 37-42, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31714270

RESUMO

PURPOSE OF REVIEW: Lung transplantation can be performed off-pump, with sequential one-lung ventilation, or using mechanical circulatory support (MCS). MCS can either be in the form of cardiopulmonary bypass (CPB) or veno-arterial or veno-venous extracorporeal membrane oxygenation (VA ECMO or VV ECMO).This article reviews the indications, benefits and limitations of these different techniques and evaluates their effect on outcomes. RECENT FINDINGS: Recently, there has been a shift toward intraoperative ECMO support and away from CPB. The first results of this strategy are promising. The use of intraoperative ECMO with the possibility of prolongation of MCS into the postoperative period has been shown to lead to improved survival when compared with lung transplants not receiving ECMO. Recipients of organs from extended criteria donors show encouraging survival rates when the lungs are reperfused using MCS. A recent metaanalysis comparing ECMO versus CPB showed favourable outcomes supporting the use of ECMO despite not finding a difference in mortality between the two methods. SUMMARY: The trend toward ECMO and away from cardiopulmonary bypass is backed up with good survival rates. However, to date, there has not been a randomized controlled trial to further guide the choice of MCS strategy for lung transplantation.


Assuntos
Oxigenação por Membrana Extracorpórea , Transplante de Pulmão , Ponte Cardiopulmonar , Humanos , Período Pós-Operatório
17.
Curr Opin Anaesthesiol ; 33(1): 55-63, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31833867

RESUMO

PURPOSE OF REVIEW: Anesthesia for the resection and reconstruction of the tracheobronchial tree for neoplastic disease is challenging, both from surgical as well as anesthetic points of view. There are no published recommendations or guidelines addressing anesthetic and airway management dilemmas that arise during these surgical interventions. This review presents key aspects of preoperative imaging evaluation, surgical planning, as well as anesthesia and airway management during these complex cases. RECENT FINDINGS: Newly published articles highlight both the surgical and anesthetic challenges encountered during tracheobronchial resections and emphasize the importance of creating specialized, high-volume centers for good patient outcomes. Of great importance is the development of a preoperative joint anesthetic-surgical plan which includes a patient-specific airway management strategy. This review presents newer and less commonly employed anesthetic management strategies which have been recently described in the literature to allow expansion of care to patients who were previously deemed too high risk for surgery. SUMMARY: With advances in technology, the use of classical ventilation methods in conjunction with newer alternatives, such as extracorporeal membrane oxygenation, creates the premise for a more individualized, safer and controlled approach to tracheobronchial resections for oncologic purposes.


Assuntos
Anestesia , Anestésicos , Oxigenação por Membrana Extracorpórea , Neoplasias , Anestesia/métodos , Humanos , Neoplasias/cirurgia , Cuidados Pré-Operatórios
18.
Radiol Clin North Am ; 58(1): 151-165, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31731898

RESUMO

Patients hospitalized in the intensive care unit (ICU) often have multiple support lines and devices that need routine imaging evaluation by radiologists. In patients with cardiogenic shock or depressed cardiac function, mechanical circulation support devices are used in combination with medical therapies to improve patient outcomes and sometimes can stabilize patients for surgical intervention. This article discusses some of the more commonly encountered mechanical circulation devices seen in ICU patients, including intra-aortic balloon pumps, Impella devices, extracorporeal membrane oxygenation cannulas, and ventricular assist devices. Normal appearance and commonly encountered device-related complications that can be diagnosed on imaging are reviewed.


Assuntos
Oxigenação por Membrana Extracorpórea/instrumentação , Coração Auxiliar , Coração/diagnóstico por imagem , Balão Intra-Aórtico/instrumentação , Tomografia Computadorizada por Raios X/métodos , Cuidados Críticos/métodos , Humanos , Radiografia/métodos
19.
J Craniomaxillofac Surg ; 48(1): 90-97, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31874806

RESUMO

BACKGROUND: The vessel-depleted, irradiated, and frozen neck, as well as severe atherosclerosis of recipient vessels represent challenging problems in free flap transfer. Extracorporeal free flap perfusion theoretically allows free flap reconstructions in the absence of local donor vessels, but is associated with a number of technical issues. In this study, a novel technique is presented using a commercially available system for extracorporeal membrane oxygenation (ECMO), modified for small blood volumes. METHODS: After preclinical testing, an ECMO system certified for lung support was used to establish blood flow through the flap's artery with oxygenation, decarboxylation and warming of diluted packed blood cells. Venous blood was allowed to flow passively into a separate container. Perfusion was performed for 15 min at intervals of 4 h over 4-6 days. RESULTS: Five patients with soft tissue defects requiring free flap reconstruction were included. Either primarily thinned anterolateral thigh (ALT) flaps (n = 3) or radial forearm flaps (n = 2) were used. We observed infection of the perfusate, with consequent subtotal flap loss, in one patient, complete epithelial loss in two patients, venous congestion in one case, and almost uneventful healing in the fifth patient. With conservative wound care and a split thickness skin graft in one case, stable wound coverage was achieved in all patients except one, who had secondary healing. None of the patients required a second flap for sufficient coverage. CONCLUSIONS: The technique described is associated with the risks of infection, flap congestion, nutritive hypoperfusion, and consequent tissue loss. Nevertheless, stable defect closure seems to be achievable even in patients with depleted recipient vessels.


Assuntos
Oxigenação por Membrana Extracorpórea , Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Transplante de Pele , Coxa da Perna
20.
Medicine (Baltimore) ; 98(49): e18292, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804375

RESUMO

RATIONALE: Fulminant myocarditis (FM) has poor prognosis and the usual treatment is inotropes and symptomatic support. The initiation of extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pumping (IABP) in the emergency department (ED) is a rare event. PATIENT CONCERNS: We report the case of a 45-year-old man with a complaint of 4 days of high fever and dry cough in the emergency department. DIAGNOSIS: Transthoracic echocardiogram and the medical history showed presumptive diagnosis was fulminant myocarditis with cardiogenic shock. INTERVENTIONS: The patient's condition deteriorated drastically and ECMO was initiated immediately after admission. He experienced electrical storm twice during ECMO support and was successfully treated with the combination with IABP. OUTCOMES: ECMO and IABP were continued for 11 and 14 days respectively. The patient was discharged on the 81th day after admission, with all his laboratory tests returned to normal. LESSONS SUBSECTIONS: The early initiation of ECMO and IABP in the ED is potentially life-saving for suitable patients with FM. It appears promising but has not yet been routinely implemented in underdeveloped and developing countries.


Assuntos
Oxigenação por Membrana Extracorpórea , Balão Intra-Aórtico , Miocardite/terapia , Choque Cardiogênico/terapia , Ecocardiografia , Serviço Hospitalar de Emergência , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/diagnóstico por imagem , Choque Cardiogênico/diagnóstico por imagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA