• Pediatric Infection and Vaccine
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• 제25권2호
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• pp.101-106
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• 2018

6세 남아가 인플루엔자 A 바이러스 감염 이후 급성 호흡부전 상태에서 내원하였다. 기관 삽관 이후 인공 호흡 및 산화 질소공급에도 호흡성 산증 및 저산소증의 호전이 없어 내원 9시간 이후 체외막 산소 공급을 이용하여 호흡 보조를 시행하였다. 내원 12시간 이후 기관지경을 이용하여 우측 중간 기관지부터 상엽 구멍을 막고 있는 단단한 점액 마개를 제거하였다. 이후 환자는 신경계와 호흡기계 후유증 없이 퇴원하였다. 저자들은 플라스틱 기관지염으로 인한 급성 호흡 부전 상태의 환자에서 신속한 체외막 산소 공급 및 기관지경술의 처치를 시행함으로써 후유증 없이 치료한 사례를 보고한다.

• Pediatric Infection and Vaccine
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• 제26권1호
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• pp.71-79
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• 2019

8세 남아가 호흡곤란과 기면증을 보이며 응급실에 내원하였다. 극도의 호흡부전을 보이고 있었고 고유량의 산소 공급을 함에도 불구하고 88-90%로 밖에 유지되지 않았고 단순 흉부 방사선 검사에서 전 폐야에 불투과도가 증가하였고 중등도의 흉수를 보였다. 마이코플라스마 폐렴 진단 하에 정맥 macrolide 를 포함한 항생제 치료를 시작하였으나 2병일 째 간, 신장에 다기관 부전 및 급성 호흡부전 증상을 보였다. 정맥-정맥 체외순환막성산소화기를 삽입하였고 지속적 신대체요법도 병행하였다. 18병일 째 성공적으로 체외순환막성산소화기에서 이탈하였고 저산소성 뇌 손상 없이 성공적으로 치료되었기에 본 사례를 보고한다.

• Journal of Chest Surgery
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• 제42권5호
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• pp.630-634
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• 2009

International Society for Heart and Lung Transplantation (ISHLT)는 2007년 보고에서 선천성 심질환, 1세 미만의 나이, 이식 당시 체외 막형 산소화 보조가 심장 이식 후 사망의 유의한 위험 요소임을 보고하였으며, 몸무게 차이가 클 경우에도 사망의 위험도를 높인다고 하였다. 이 증례의 환아는 심한 좌심실 유출로 협착, 승모판 폐쇄 부전이 있어 Ross수술과 승모판 성형술을 시행하였으나 술 후 심한 좌심실 기능부전으로 체외 막형 산소화 보조를 적용하였다. 체외 막형 산소화 보조 30일이 경과한 생후 3개월 경 공여자-수용자간 몸무게 비가 4.42에 이르는 매우 큰 심장을 성공적으로 이식하였기에 이식의 기술적인 주요 사항을 문헌 고찰과 함께 보고하는 바이다.

• Journal of Trauma and Injury
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• 제27권1호
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• pp.5-8
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• 2014

Although blunt traumatic cardiac rupture is an uncommon injury, it can be associated with a high mortality rate. Two cases of cardiac rupture in blunt trauma patients are described herein. In those cases, applications of mechanical support devices such as ECMO (extracorporeal membrane oxygenation) and early surgery for exploration under cardiopulmonary bypass may be helpful for treating blunt chest trauma patients.

• Tuberculosis and Respiratory Diseases
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• 제73권1호
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• pp.1-10
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• 2012

Care of patients with sepsis has improved over the last decade. However, in the recent two years, there was no significant progress in the development of a new drug for critically ill patients. In January 2011, it was announced that the worldwide phase 3 randomized trial of a novel anti-Toll-like receptor-4 compound, eritoran tetrasodium, had failed to demonstrate an improvement in the mortality of patients with severe sepsis. In October 2011, Xigris (drotrecogin alfa, a recombinant activated protein C) was withdrawn from the market following the failure of its worldwide trial that had attempted to demonstrate improved outcome. These announcements were disappointing. The recent failure of 2 promising drugs to further reduce mortality suggests that new approaches are needed. A study was published showing that sepsis can be associated to a state of immunosuppression and loss of immune function in human. However, the timing, incidence, and nature of the immunosuppression remain poorly characterized, especially in humans. This emphasizes the need for a better understanding of sepsis as well as new therapeutic strategies. Many clinical experiences of the extracorporeal membrane oxygenator (ECMO) treatment for adult acute respiratory distress syndrome (ARDS) patients, which is caused by the H1N1 influenza A virus, were reported. The use of ECMO in severe respiratory failure, particularly in the treatment of adult ARDS, is occurring more commonly.

• Journal of Chest Surgery
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• 제48권5호
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• pp.318-327
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• 2015

Background: With improvements in cardiopulmonary resuscitation (CPR) techniques, the quality and the effectiveness of CPR have been established; nevertheless, the survival rate after cardiac arrest still remains poor. Recently, many reports have shown good outcomes in cases where extracorporeal membrane oxygenation (ECMO) was used during prolonged CPR. Accordingly, we attempted to evaluate the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on the survival of patients who experienced a prolonged cardiac arrest and compared it with that of conventional CPR (CCPR). Methods: Between March 2009 and April 2014, CPR, including both in-hospital and out-of-hospital CPR, was carried out in 955 patients. The ECPR group, counted from the start of the ECPR program in March 2010, included 81 patients in total, and the CCPR group consisted of 874 patients. All data were retrospectively collected from the patients' medical records. Results: The return of spontaneous circulation (ROSC) rate was 2.24 times better in CPR of in-hospital cardiac arrest (IHCA) patients than in CPR of out-of-hospital CA (OHCA) patients (p=0.0012). For every 1-minute increase in the CPR duration, the ROSC rate decreased by 1% (p=0.0228). Further, for every 10-year decrease in the age, the rate of survival discharge increased by 31%. The CPR of IHCA patients showed a 2.49 times higher survival discharge rate than the CPR of OHCA patients (p=0.03). For every 1-minute increase in the CPR duration, the rate of survival discharge was decreased by 4%. ECPR showed superiority in terms of the survival discharge in the univariate analysis, although with no statistical significance in the multivariate analysis. Conclusion: The survival discharge rate of the ECPR group was comparable to that of the CCPR group. As the CPR duration increased, the survival discharge and the ROSC rate decreased. Therefore, a continuous effort to reduce the time for the decision of ECMO initiation and ECMO team activation is necessary, particularly during the CPR of relatively young patients and IHCA patients.

• Journal of Chest Surgery
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• 제56권3호
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• pp.224-227
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• 2023

Median sternotomy is a standard surgical technique used for left ventricular assist device (LVAD) implantation. However, if sternotomy has a prohibitive surgical risk, LVAD implantation can be performed through only left thoracotomy. We managed a patient with end-stage heart failure who had recently undergone coronary artery bypass grafting (CABG) elsewhere. The patient also had a deep sternal wound infection and bacteremia. Because of refractory cardiogenic shock, we performed extracorporeal membrane oxygenation (ECMO). After multiple mediastinal washouts and omental flap placement, ECMO was converted to extracorporeal LVAD (from the left ventricular apex to the descending aorta) through a left thoracotomy. The extracorporeal LVAD was maintained for 18 days and replaced by the HeartMate 3 LVAD. The patient was discharged in good condition 115 days after CABG.

• 대한의용생체공학회:의공학회지
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• 제45권3호
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• pp.128-137
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• 2024

It is necessary to develop a pulsatile Extracorporeal Membrane Oxygenator (p-ECMO) with counter-pulsation control(CPC), which ejects blood during the diastolic phase of the heart rather than the systolic phase, due to the known issues with conventional ECMO causing fatal complications such as ventricular dilation and pulmonary edema. A promising method to simultaneously detect the pulsations of the heart and p-ECMO is to analyze blood pressure waveforms using deep neural network technology(DNN). However, the accurate detection of cardiac rhythms by DNNs is challenging due to various noises such as pulsations from p-ECMO, reflected waves in the vessels, and other dynamic noises. This study aims to evaluate the accuracy of DNNs developed for CPC in p-ECMO, using human-like blood pressure waveforms reproduced in an in-vitro experiment. Especially, an experimental setup that reproduces reflected waves commonly observed in actual patients was developed, and the impact of these waves on DNN judgments was assessed using a multiple DNN (m-DNN) that provides accurate determinations along with a separate index for heartbeat recognition ability. In the experimental setup inducing reflected waves, it was observed that the shape of the blood pressure waveform became increasingly complex, which coincided with an increase in harmonic components, as evident from the Fast Fourier Transform results of the blood pressure wave. It was observed that the recognition score (RS) of DNNs decreased in blood pressure waveforms with significant harmonic components, separate from the frequency components caused by the heart and p-ECMO. This study demonstrated that each DNN trained on blood pressure waveforms without reflected waves showed low RS when faced with waveforms containing reflected waves. However, the accuracy of the final results from the m-DNN remained high even in the presence of reflected waves.

• Journal of Chest Surgery
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• 제44권2호
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• pp.193-196
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• 2011

Bronchogenic carcinoma involving the carina has remained a challenging problem for thoracic surgeons. Carinal resection and reconstruction is limitedly indicated because this aggressive surgical approach has been reported to be associated with significant morbidity and mortality while long-term outcome has not been determined. Wesuccessfully performed carinal reconstruction and sleeve right upper lobectomy assisted with ECMO for a 60-year-old male with squamous cell carcinoma in the right upper lobe extending to the carina.

• International Journal of Fluid Machinery and Systems
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• 제8권1호
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• pp.1-12
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• 2015

In cardiopulmonary support systems with a membrane oxygenation such as a percutaneous cardiopulmonary support (PCPS) or an extracorporeal membrane oxygenation (ECMO), blood pumps need to generate the pressure rise of approximately 200mmHg or higher, due to the high hydraulic resistances of the membrane oxygenation and of the cannula tubing. In order to realize the blood pump with higher pressure rise, higher anti-hemolysis and thrombosis performances, the development of novel centrifugal blood pump composed of two-stage has been conducted by the authors. In the present paper, effective attempts to decrease the wall shear stress and to suppress the stagnation are introduced for the prevention of hemolysis and thrombosis in blood pumps. The hemolysis test was also carried out and it was clarified that the decrease of wall shear stress is effective as a guideline of design of blood pumps for improving the anti-hemolysis performance.