Advances in Extra-corporeal Perfusion Therapies最新文献

Cardiogenic Shock 心原性休克

Advances in Extra-corporeal Perfusion Therapies Pub Date : 2019-01-10 DOI: 10.5772/intechopen.76688

Fevzi Sarper Türker

{"title":"Cardiogenic Shock","authors":"Fevzi Sarper Türker","doi":"10.5772/intechopen.76688","DOIUrl":"https://doi.org/10.5772/intechopen.76688","url":null,"abstract":"Cardiogenic shock (CS) is an end-organ hypoperfusion associated with heart failure. Any reason impairing acute left ventricular (LV) or right ventricular (RV) function may cause CS. The only way to avoid CS is to provide early reperfusion in myocardial infarction (MI) patients. CS is characterized by permanent or transient rearrangement of the entire circulatory system. According to the current IABP-SHOCK II trial, 74% of the patients with CSMI are treated with norepinephrine, 53% of them with dobutamine, 26% of them with epinephrine, 4% of them with levosimendan, and 4% of them with dopamine. Percutaneous circulatory support devices such as intra-aortic balloon pump (IABP), LV assist device (LVAD), or extracorporeal life support (ECLS) create treatment options for selected patients such as CS, cardiopulmonary resuscitation, or high-risk pPCI and CABG. Extracorporeal Life Support Organization (ELSO, 2017) evaluated that the use of ECLS/VA-ECMO should be considered when the mortality risk exceeds 50% despite optimal conventional treatment in case of acute severe heart or pulmonary failure, whereas it should be assessed as a primary indication when it exceeds 80%. Early and effective revascularization is the best treatment option for CS. Thus, the organizations on the national and global basis will play the most effective role for the short- and long-term survival of patients.","PeriodicalId":366209,"journal":{"name":"Advances in Extra-corporeal Perfusion Therapies","volume":"204 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124572664","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

Flow Optimization, Management, and Prevention of LV Distention during VA-ECMO VA-ECMO期间左室扩张的血流优化、管理和预防

Advances in Extra-corporeal Perfusion Therapies Pub Date : 2018-12-07 DOI: 10.5772/INTECHOPEN.80265

Cristiano Amarelli, F. Musumeci, A. Loforte, AndreaMontalto, Sveva Di Franco, J. Hernandez‐Montfort

{"title":"Flow Optimization, Management, and Prevention of LV Distention during VA-ECMO","authors":"Cristiano Amarelli, F. Musumeci, A. Loforte, AndreaMontalto, Sveva Di Franco, J. Hernandez‐Montfort","doi":"10.5772/INTECHOPEN.80265","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.80265","url":null,"abstract":"Cardiogenic shock (CS) still carries an unacceptably high mortality (30–60%), despite several therapeutic approaches; the SHOCK II trial questioned the benefit of intra-aortic balloon pump (IABP), while IMPRESS and CULPRIT-SHOCK trials confirmed hetero- geneity in disease spectrum and patient selection for acute myocardial infarction-related CS requiring acute mechanical circulatory support (AMCS). The heterogeneity of devices employed as AMCS, including temporary micro-axial flow pumps (Impella), percutaneous bypass (TandemHeart), and extracorporeal life support (VA-ECMO), contributed to the actual dramatic scenario, where CS is defined clinically rather than hemodynami-cally. To date, the role of VA-ECMO is emerging as rapid strategy to mitigate mortality rates of severe refractory states, despite the lack of data regarding the best practices of management and flows control. VA-ECMO’s flow represents the “dose” of treatment and higher flows are less tolerated percutaneously requiring, to prevent deleterious pulmonary edema and ventricular distention, additional approaches such as pulmonary, left atrial, or left ventricular unloading. Any efforts have to be directed to (1) determine adequate management of patients on VA-ECMO, (2) define the safer duration of VA-ECMO support, and (3) establish algorithms and techniques to predict and obtain stable weaning from ECMO or ensure fast transition to durable VAD and/or heart transplant .","PeriodicalId":366209,"journal":{"name":"Advances in Extra-corporeal Perfusion Therapies","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133495712","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

Ventricular Assist Devices 心室辅助装置

Advances in Extra-corporeal Perfusion Therapies Pub Date : 2018-11-20 DOI: 10.5772/INTECHOPEN.79509

F. Özalp, S. Schueler

{"title":"Ventricular Assist Devices","authors":"F. Özalp, S. Schueler","doi":"10.5772/INTECHOPEN.79509","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79509","url":null,"abstract":"Heart failure is a common and debilitating disease with about 40 million affected worldwide. While there has been some improvement in the optimal medical therapy over the last two decades there is a worldwide stagnation in the number of heart transplantations which is only available to a very few selected patients. The emergence and progress in mechanical circulatory support strategies over the same period has provided a real hope for those patients who have otherwise similar life expectancy to terminal cancer patients. Devices like the IABP have been around for longer but it was the advent of extracorporeal pulsatile and especially the so-called second and third generation ventricular assist devices that provided a real progress in the surgical treatment of heart failure. Devices like the HeartMate II and the HeartWare MVAD found widespread application as intracorporeal continues-flow left ventricular assist devices. Initially the licences were for bridge to transplantation but more and more patients are now receiving these devices as destination therapy. There are certain specific complications like device thrombosis, bleeding and driveline infection that are related to these devices and are the focus of current research and development so that over the next decade or so that we can anticipate that newer devices may provide a direct alternative to transplantation with the advantage of its availability off the shelf. The ensuing increased usage of these devices will possibly reduce the cost to more affordable rates for the health care providing institutions worldwide which will make them available to millions of patients who have otherwise a very bleak outcome.","PeriodicalId":366209,"journal":{"name":"Advances in Extra-corporeal Perfusion Therapies","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131698645","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

Mechanical Circulatory Support (MCS) for Primary Graft Dysfunction (PGD) 机械循环支持(MCS)治疗原发性移植物功能障碍(PGD)

Advances in Extra-corporeal Perfusion Therapies Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.76697

L. Caneo, Vitor Barzilai

引用次数: 0

Severe Acute Respiratory Distress Syndrome 严重急性呼吸窘迫综合征

Advances in Extra-corporeal Perfusion Therapies Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.77071

C. Barbas, Roberta Fittipaldi Palazo, G. F. J. Matos

{"title":"Severe Acute Respiratory Distress Syndrome","authors":"C. Barbas, Roberta Fittipaldi Palazo, G. F. J. Matos","doi":"10.5772/INTECHOPEN.77071","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.77071","url":null,"abstract":"Acute respiratory distress syndrome is characterized by an increase of the permeability of the lungs’ alveolar-capillary membranes, leading to the extravasation of liquid rich in proteins inside the alveolar spaces that turns air-filled lungs into heavy high-osmotic pres - sure liquid-filled lungs. The consequence is the collapse of the lowermost lung regions, shunt, refractory hypoxemia, decrease in lungs’ compliance and increase in dead spaces that are more pronounced with the severity of the permeability changes of the pulmonary alveoli-capillary membrane. According to the recent Berlin definition, severe acute respi - ratory distress syndrome is defined by bilateral pulmonary infiltrates of recent onset (less than 1 week) in a patient with a risk factor for ARDS that has a PaO 2 /FIO 2 equal or less than 100 with a positive end-expiratory pressure equal or more than 5 cm H 2 O with no evidence of cardiac failure or hypervolemia. Severe ARDS patients present a higher mor - tality ratio, a more difficult mechanical ventilatory support (higher airway pressures with low tidal ventilation and higher PaCO 2 levels) and benefits for adjunctive ventilatory sup - port therapy. The recommended mechanical ventilatory support in severe ARDS is with low tidal ventilation (less than 6 mL/Kg predicted body weight) with driving inspiratory pressures less than 15 cm H 2 O, respiratory rate sufficient to keep adequate minute venti - lation and PaCO 2 levels. PEEP higher than 15 cm H 2 O and prolonged prone position are recommended for more severe patients to improve their survival. Adjunctive recruitment maneuvers can be used to improve oxygenation and allow more homogeneous ventila - tion and PEEP titration. In refractory hypoxemia and especially in younger patients with prognosis, extra-corporeal veno-venous membrane oxygenation support can be used .","PeriodicalId":366209,"journal":{"name":"Advances in Extra-corporeal Perfusion Therapies","volume":"104 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115898562","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: 6

Introductory Chapter: ECMO - Growing Indications, Applications, and Understanding of a Complex Supportive Therapy 导论章:ECMO -生长适应症、应用和对复杂支持治疗的理解

Advances in Extra-corporeal Perfusion Therapies Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.81777

M. Firstenberg, Jennifer Hanna

{"title":"Introductory Chapter: ECMO - Growing Indications, Applications, and Understanding of a Complex Supportive Therapy","authors":"M. Firstenberg, Jennifer Hanna","doi":"10.5772/INTECHOPEN.81777","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.81777","url":null,"abstract":"This volume represents the second in a series of texts focused on extra-corporeal membrane oxygenation (ECMO), also known as extra-corporeal life support (ECLS) [1]. Over the years, there has been a continuous evolution of this therapy from a salvage form employed only in extreme cases in which all other treatment options have failed to a technology which is now considered a critical component in the toolbox of therapies and technologies used for acute cardiopulmonary failure. While initial experiences reported few survivors, these poor outcomes clearly had multifactorial etiologies [2]. Difficulties with primitive pump and circuit designs and technologies, a poor understanding of which patients derive the greatest benefit from this therapy, little understanding of the long-term physiologic implications of patient-circuit biologic interactions, a lack of management guidelines, and a generally limited understanding of managing patients and therapy-related complications while on “longer” term cardiopulmonary bypass have all contributed to the complexities of successful implementation of ECMO into mainstream medical and surgical practices. Nevertheless, over the past three decades, there has been continued refinement in all aspects of ECMO therapies, with a growing understanding of the role of ECMO as a life-saving therapy and potential bridge to transplantation while awaiting organ availability. ECMO has evolved into a treatment option that allows for an acutely injured heart and or lungs to heal, either allowing for recovery or serving as a “bridge” to a more definitive long-term end-organ replacement option such as ventricular assist devices or cardiopulmonary transplantation [3]. Many of these complex topics are addressed in this contemporary volume. However, there remains, without a doubt, much more to learn and understand. The successes of the ECMO technology","PeriodicalId":366209,"journal":{"name":"Advances in Extra-corporeal Perfusion Therapies","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126383294","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 (ECMO) for Long-Term Support: Recent Advances 体外膜氧合(ECMO)用于长期支持:最新进展

Advances in Extra-corporeal Perfusion Therapies Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.76506

R. G. Conway, D. Tran, B. Griffith, Zhongjun J. Wu

{"title":"Extracorporeal Membrane Oxygenation (ECMO) for Long-Term Support: Recent Advances","authors":"R. G. Conway, D. Tran, B. Griffith, Zhongjun J. Wu","doi":"10.5772/INTECHOPEN.76506","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76506","url":null,"abstract":"Considerable progress has been made in component technology, circuitry, and clinical practice related to extracorporeal membrane oxygenation (ECMO). These advances allow prolonged support with fewer complications when compared to the past eras. Long-term support cases were frequently reported with indications including respiratory failure, cardiac failure, bridge to transplantation, extracorporeal cardiopulmonary resuscitation (ECPR), and even ambulatory extracorporeal membrane oxygenation (ECMO) support. The common complications associated with ECMO, including thrombosis, hemorrhage, nosocomial infection, neurological injury, vessel injury, multiple organ failure and mechanical failure, and the disease process of patients remain limiting factors. In spite of the complications, ECMO remains the only possible option in treatments for patients requiring long-term respiratory or cardiopulmonary support. In this chapter, the recent advances in long-term ECMO support are reviewed. Clinical etiology of patients placed on long-term ECMO support, the various circuit configurations, clinical and technical issues, management aspects, and clinical outcomes are discussed.","PeriodicalId":366209,"journal":{"name":"Advances in Extra-corporeal Perfusion Therapies","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130435121","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: 3

Education Curriculum on Extracorporeal Membrane Oxygenation: The Evolving Role of Simulation Training 体外膜氧合教育课程:模拟训练的演变作用

Advances in Extra-corporeal Perfusion Therapies Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.76656

Simon Sin Wai Ching, P. Ng, Wallace Ngai Chun Wai, Peter Lai Chi Keung, Ricky Chan Wai Kit, Andy Mok Yuen Tin

{"title":"Education Curriculum on Extracorporeal Membrane Oxygenation: The Evolving Role of Simulation Training","authors":"Simon Sin Wai Ching, P. Ng, Wallace Ngai Chun Wai, Peter Lai Chi Keung, Ricky Chan Wai Kit, Andy Mok Yuen Tin","doi":"10.5772/INTECHOPEN.76656","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76656","url":null,"abstract":"Continuing education is essential for the success and safety of an extracorporeal membrane oxygenation (ECMO) programme. However, it is challenging due to the intrinsic charac-teristic of ECMO—a complex, high-risk, low-volume clinical activity which require team- work, inter-professional communication, critical decision and rapid response especially in emergency. Thus, simulation is a rapidly evolving teaching methodology in ECMO education to address those training needs that cannot be entirely addressed by traditional teaching modalities. The development of a simulation programme requires commitment on resources for equipment, environment setup and training of personnel. Knowledge on ECMO management, education science and debriefing technique forms the cornerstone of successful ECMO simulation facilitators and hence the simulation programme. Currently, researches have already shown that ECMO simulation can improve individual and team performance despite that its impact on patient outcome is still unknown. In the future, the role of simulation will increase importantly in multicentre research, certifying specialists and credentialing if standardization of training curriculum can be achieved.","PeriodicalId":366209,"journal":{"name":"Advances in Extra-corporeal Perfusion Therapies","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128292472","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 Use in Asphyxiated Newborns Treated with Hypothermia: Review of the Current Evidence 体外膜氧合用于低温治疗的窒息新生儿:当前证据的回顾

Advances in Extra-corporeal Perfusion Therapies Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.78761

A. A. Balushi, S. Zavalkoff, P. Wintermark

{"title":"Extracorporeal Membrane Oxygenation Use in Asphyxiated Newborns Treated with Hypothermia: Review of the Current Evidence","authors":"A. A. Balushi, S. Zavalkoff, P. Wintermark","doi":"10.5772/INTECHOPEN.78761","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.78761","url":null,"abstract":"Asphyxiated newborns may be hemodynamically unstable during their first days of life. They often present with severe persistent pulmonary hypertension and/or car diac dysfunction, which may require aggressive supportive management to maintain homeostasis and prevent further brain injury. In the most severe cases, extracorporeal membrane oxygenation (ECMO) may be required to ensure adequate oxygenation, ventilation and cardiac output. However, due to the risk of irreversible brain injury, clinicians often are concerned about offering ECMO to these newborns. Therapeutic hypothermia during the first days of life has become the standard of care for these newborns to improve their prognosis; however, this treatment in itself has been associ - ated with increased hemodynamic instability and coagulopathy. An additional con cern with using ECMO in these newborns is the potential increased bleeding risk when continuing the hypothermia treatment during the ECMO course. This chapter reviews the reported feasibility of performing hypothermia during ECMO. We also review the reported outcomes of asphyxiated newborns treated with hypothermia and ECMO and highlight their potential survival without neurodevelopmental impairments. Thus, ECMO should be considered as a therapeutic option for asphyxiated newborns treated with hypothermia. 0.0005","PeriodicalId":366209,"journal":{"name":"Advances in Extra-corporeal Perfusion Therapies","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131599254","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

Percutaneous Mechanical Circulatory Support Devices: Systems and Clinical Options 经皮机械循环支持装置:系统和临床选择

Advances in Extra-corporeal Perfusion Therapies Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.76925

A. Loforte, G. Coppola, C. Mariani, G. Gliozzi, F. Grigioni, G. Marinelli

引用次数: 0