Advances in Extracorporeal Membrane Oxygenation - Volume 3最新文献

ECMO Weaning Strategies to Optimize Outcomes ECMO脱机策略优化预后

Advances in Extracorporeal Membrane Oxygenation - Volume 3 Pub Date : 2019-12-04 DOI: 10.5772/intechopen.85614

J. S. Enciso, K. Hong

{"title":"ECMO Weaning Strategies to Optimize Outcomes","authors":"J. S. Enciso, K. Hong","doi":"10.5772/intechopen.85614","DOIUrl":"https://doi.org/10.5772/intechopen.85614","url":null,"abstract":"Survival to discharge in patients presenting with cardiogenic shock who are managed using extracorporeal membrane oxygenation (ECMO) remains low at ~50%. This speaks to the acuity and severity of individuals being placed on ECMO, as well as the time dependent risk for complications associated with this therapy. Although some patients are able to be weaned from ECMO to either recovery, left ventricular assist device or heart transplantation, other individuals do not survive after device removal, suggesting that current protocols may not be identifying individuals with enough intrinsic cardiac recovery to maintain adequate end-organ perfusion. The decision to wean an individual from ECMO is complex and entails several factors that are dynamic and evolving daily while on full circulatory support. Objective clinical, hemodynamic and biological markers are needed to be controlled prior to trialing device weans but many times the decision relies on clinical experience and intuition. The purpose of this chapter will be to: (1) outline the survival and risks associated with ECMO which encourages early weaning trials and (2) identify patient factors related to either successful weaning or early referral for durable mechanical support or transplant.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"61 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120989259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Introductory Chapter: ECMO – Rapidly Evolving Technology, Expanding Indications, and Growing Challenges 导论章:ECMO -快速发展的技术，扩大适应症和日益增长的挑战

Advances in Extracorporeal Membrane Oxygenation - Volume 3 Pub Date : 2019-12-04 DOI: 10.5772/intechopen.89475

M. Firstenberg, J. Hanna

引用次数: 0

Finding a Bridge to Somewhere: An Ethical Framework for Veno-Arterial Extracorporeal Membrane Oxygenation Decisions 寻找通往某处的桥梁:静脉-动脉体外膜氧合决策的伦理框架

Advances in Extracorporeal Membrane Oxygenation - Volume 3 Pub Date : 2019-10-07 DOI: 10.5772/intechopen.85702

J. Aultman, M. Firstenberg

{"title":"Finding a Bridge to Somewhere: An Ethical Framework for Veno-Arterial Extracorporeal Membrane Oxygenation Decisions","authors":"J. Aultman, M. Firstenberg","doi":"10.5772/intechopen.85702","DOIUrl":"https://doi.org/10.5772/intechopen.85702","url":null,"abstract":"Extracorporeal membrane oxygenation (ECMO) is an established therapy for the management of acute cardiopulmonary failure. A substantial concern when considering ECMO therapy is whether the patient will recover enough function to be weaned from support and survive to discharge. The concept of “a bridge to nowhere” is where a patient is supported on a therapy for which there is no hope for recovery and would, by definition, immediately die if support is discontinued—a somewhat unique concept in clinical medicine, but often considered when considering short-term mechanical support for acute heart and/or lung failure. Much like initiating mechanical ventilator support in patients who have no chance of meaningful recovery, there are concerns about embarking on or continuing with ECMO support in patients in whom recovery is unlikely. The purpose of this chapter is to review the ethical foundation and principles to support the clinical decision-making process when there are concerns regarding the initiation, continuation, or withdrawal of this highly invasive, resource-intensive life-support technology. Specific attention will be given to well-established principles of the ethical application of advanced life support and how to appropriately limit offering or continuing therapies for which meaningful outcomes are unlikely or further support is considered futile.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130429516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation 儿童体外膜氧合抗凝

Advances in Extracorporeal Membrane Oxygenation - Volume 3 Pub Date : 2019-08-22 DOI: 10.5772/INTECHOPEN.85104

J. Weller, Lakshmi Raman, A. Zia, A. McMichael

引用次数: 0

Nursing Implications in the ECMO Patient ECMO患者的护理意义

Advances in Extracorporeal Membrane Oxygenation - Volume 3 Pub Date : 2019-06-12 DOI: 10.5772/INTECHOPEN.85982

A. Botsch, Elizabeth Protain, Amanda R. Smith, R. Szilagyi

{"title":"Nursing Implications in the ECMO Patient","authors":"A. Botsch, Elizabeth Protain, Amanda R. Smith, R. Szilagyi","doi":"10.5772/INTECHOPEN.85982","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85982","url":null,"abstract":"Effective care and positive outcomes of the extracorporeal membrane oxygenation (ECMO) patient necessitate optimal interdisciplinary management from the healthcare team, including expert care from specially trained registered nurses (RNs). It is incumbent upon the RN caring for the ECMO patient to excel in both time management and assessment skills, as this population often demands care delivery at the pinnacle of intensive care unit (ICU) acuity. Astute and nuanced monitoring of neurological status, bleeding risk with potential (often massive) transfusions, poor hemodynamics, and integrity of the ECMO pump itself are only the few specialized areas of focus that must share priority with traditional nursing considerations involving the critically ill, such as prevention of pressure injuries and bloodstream infections. These high-intensity medical foci must be balanced with ethical considerations, as the ultimate goal of returning the patient to their normal life is not always possible. These demands highlight the dynamic proficiency of the RN caring for the ECMO patient. The following chapter will highlight the importance of specialized nursing care in the critically ill patient supported with ECMO.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130205022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Extracorporeal Cardiopulmonary Resuscitation 体外心肺复苏

Advances in Extracorporeal Membrane Oxygenation - Volume 3 Pub Date : 2019-06-05 DOI: 10.5772/INTECHOPEN.83658

Abdelaziz Farhat, C. Bowens, R. Thiagarajan, Lakshmi Raman

{"title":"Extracorporeal Cardiopulmonary Resuscitation","authors":"Abdelaziz Farhat, C. Bowens, R. Thiagarajan, Lakshmi Raman","doi":"10.5772/INTECHOPEN.83658","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.83658","url":null,"abstract":"ECMO, or extracorporeal membrane oxygenation, is an advanced life support technique that provides cardiac and pulmonary support similar to cardiopulmonary bypass. ECPR (extracorporeal cardiopulmonary resuscitation) is the rapid deployment of VA-ECMO when conventional cardiopulmonary resuscitation fails to provide return of spontaneous circulation. Evidence in the literature is sparse, but with expanding reported applications, ECPR has shown promise to improve outcomes of cardiac arrest. ECPR is superior to conventional CPR for both survival and neurologic outcomes. ECPR has been successfully used to manage arrests secondary to cardiac and non-cardiac causes. Arrests secondary to primary cardiac causes have the best overall outcome. Other determinants of outcomes of ECPR include duration of low flow state and on-ECMO complications. A narrow list of ECPR contraindications exists, and includes severe neurologic injury and irreversible primary disease process. Various complications can occur with ECPR, and include mechanical, cardiovascular, pulmonary, hematologic, renal, and neurologic complications. Neurologic complications are the most serious, and significantly affect mortality or quality of life. ECPR is a nascent field, and substantial work remains to be done to optimize its application. Given the small number of patients at each institutional level, this is a field ripe for collaborative work and rewarding results.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125658911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Extracorporeal Membrane Oxygenation as a Bridge to Cardiac Transplantation 体外膜氧合作为心脏移植的桥梁

Advances in Extracorporeal Membrane Oxygenation - Volume 3 Pub Date : 2019-06-04 DOI: 10.5772/INTECHOPEN.84935

N. Nair, E. Góngora

{"title":"Extracorporeal Membrane Oxygenation as a Bridge to Cardiac Transplantation","authors":"N. Nair, E. Góngora","doi":"10.5772/INTECHOPEN.84935","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.84935","url":null,"abstract":"Extracorporeal membrane oxygenation (ECMO) is a technique used for tempo-rary support of patients with end-stage heart or lung failure. This review will focus on the venoarterial ECMO system and its use as a bridge to other long-term durable devices and/or cardiac transplantation. It can be used as a bridge to decision because it helps to gain time to stabilize the patient for further evaluation for long-term treatment such as durable mechanical circulatory pumps or transplantation. ECMO is evolving as a treatment for patients waiting on the transplant list. Increasing utilization of ECMO in adults has revealed some of the common complications such as bleeding and coagulopathy which impact survival in this patient population. The use of VA ECMO as a technique for rescuing patients from cardiogenic shock is very attractive. However, considering the extensive set of complications and the mortality it brings with it makes it a less attractive option as a direct bridge to cardiac transplant. The literature currently on this subject is very scanty and limited to a few studies of small numbers of patients. Further definitive research is needed for consensus on the role of VA ECMO as a bridge to cardiac transplant.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"193 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124301607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Isn’t Limb as Precious as Life? 肢体不像生命一样珍贵吗?

Advances in Extracorporeal Membrane Oxygenation - Volume 3 Pub Date : 2019-05-30 DOI: 10.5772/INTECHOPEN.86391

P. Mohite, A. Simon

引用次数: 1

Clinical and Administrative Steps to the ECMO Program Development ECMO项目发展的临床和行政步骤

Advances in Extracorporeal Membrane Oxygenation - Volume 3 Pub Date : 2019-05-14 DOI: 10.5772/INTECHOPEN.84838

Dianne McCallister, L. Pilon, Joseph Forrester, Samer Alsaleem, C. Kotaru, J. Hanna, Gregory Hickey, Rachele Roberts, E. Douglass, Matthew Libby, M. Firstenberg

引用次数: 7

Extracorporeal Carbon Dioxide Removal for the Exacerbation of Chronic Hypercapnic Respiratory Diseases 体外二氧化碳清除对慢性高碳酸血症性呼吸系统疾病加重的影响

Advances in Extracorporeal Membrane Oxygenation - Volume 3 Pub Date : 2019-05-04 DOI: 10.5772/INTECHOPEN.84936

L. Morales-Quinteros, A. Artigas

引用次数: 0