Neto, Pedro Henry;Ribeiro, Zamara Brandao;Pinho, Adriano Bastos;Almeida, Carlos Henrique Rodrigues de;Maranhao, Carlos Alberto de Albuquerque;Goncalves, Joaquim da Cunha Campos
Journal of Trauma and Injury
/
v.35
no.3
/
pp.209-214
/
2022
We describe a case of hyperbaric oxygen therapy (HBOt) as an adjunct to treatment of a crush injury to the hand. A 34-year-old male paramedic was involved in a motor vehicle accident and admitted for diagnosis and surgical treatment. He sustained a crush injury to his right hand and presented with significant muscle damage, including multiple fractures and dislocations, an avulsion injury of the flexor tendons, and amputation of the distal phalanx of the little finger. He underwent reconstructive surgery and received HBOt over the following days. In the following 2 months, he lost the distal and middle phalanges of the little finger and recovered hand function. Posttraumatic compartment syndrome responds well to HBOt, which reduces edema and contributes to angiogenesis, as well as promoting the cascade of healing events. High-energy trauma causes massive cell destruction, and the blood supply is usually not sufficient to meet the oxygen demands of viable tissues. Hyperbaric oxygenation by diffusion through interstitial and cellular fluids increases tissue oxygenation to levels sufficient for the host's responses to injury to work and helps control the delayed inflammatory reaction. HBOt used as an adjunct to surgical treatment resulted in early healing and rehabilitation, accelerating functional recovery. The results suggest that adjunctive HBOt can be beneficial for the treatment of crush injuries of the hand, resulting in better functional outcomes and helping to avoid unnecessary amputations.
Background: This study investigated mortality and morbidity in patients requiring postcardiotomy extracorporeal membrane oxygenation (ECMO) support after operations for congenital heart disease (CHD). Methods: CHD patients requiring postoperative ECMO support between May 2011 and May 2021 were retrospectively reviewed. Patients were divided into non-survivors and survivors to hospital discharge. Survival outcomes and associations of various factors with in-hospital death were analyzed. Results: Fifty patients required postoperative ECMO support. Patients' median age and weight at the time of ECMO insertion were 1.85 months (interquartile range [IQR], 0.23-14.5 months) and 3.84 kg (IQR, 3.08-7.88 kg), respectively. Twenty-nine patients (58%) were male. The median duration of ECMO support was 6 days (IQR, 3-12 days). Twenty-nine patients (58%) died on ECMO support or after ECMO weaning, and 21 (42%) survived to hospital discharge. Postoperative complications included renal failure (n=33, 66%), bleeding (n=11, 22%), and sepsis (n=15, 30%). Prolonged ECMO support (p=0.017), renal failure (p=0.005), continuous renal replacement therapy (CRRT) application (p=0.001), sepsis (p=0.012), bleeding (p=0.032), and high serum lactate (p=0.002) and total bilirubin (p=0.017) levels during ECMO support were associated with higher mortality risk in a univariate analysis. A multivariable analysis identified CRRT application (p=0.013) and a high serum total bilirubin level (p=0.001) as independent risk factors for death. Conclusion: Postcardiotomy ECMO should be considered as an important therapeutic modality for patients unresponsive to conventional management. ECMO implementation strategies and management in appropriate patients without severe complications, particularly renal failure and/or liver failure, are crucial for achieving positive outcomes.
Jun Tae, Yang;Hyoung Soo, Kim;Kun Il, Kim;Ho Hyun, Ko;Jung Hyun, Lim;Hong Kyu, Lee;Yong Joon, Ra
Journal of Chest Surgery
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v.55
no.6
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pp.452-461
/
2022
Background: Extracorporeal membrane oxygenation (ECMO) can be used in patients with refractory cardiogenic shock or respiratory failure. In South Korea, the need for transporting ECMO patients is increasing. Nonetheless, information on urgent transportation and its outcomes is scant. Methods: In this retrospective review of 5 years of experience in ECMO transportation at a single center, the clinical outcomes of transported patients were compared with those of in-hospital patients. The effects of transportation and the relationship between insertion-departure time and survival were also analyzed. Results: There were 323 cases of in-hospital ECMO (in-hospital group) and 29 cases transferred to Hallym University Sacred Heart Hospital without adverse events (mobile group). The median transportation time was 95 minutes (interquartile range [IQR], 36.5-119.5 minutes), whereas the median transportation distance was 115 km (IQR, 15-115 km). Transportation itself was not an independent risk factor for 28-day mortality (odds ratio [OR], 0.818; IQR, 0.381-1.755; p=0.605), long-term mortality (OR, 1.099; IQR, 0.680-1.777; p=0.700), and failure of ECMO weaning (OR, 1.003; IQR, 0.467-2.152; p=0.995) or survival to discharge (OR, 0.732; IQR, 0.337-1.586; p=0.429). After adjustment for covariates, no significant difference in the ECMO insertion-departure time was found between the survival and mortality groups (p=0.435). Conclusion: The outcomes of urgent transportation, with active involvement of the ECMO center before ECMO insertion and adherence to the transport protocol, were comparable to those of in-hospital ECMO patients.
Claudia Carolina Perez-Castro;Alexandre Kormanovski;Gustavo Guevara-Balcazar;Maria del Carmen Castillo-Hernandez;Jose Ruben Garcia-Sanchez;Ivonne Maria Olivares-Corichi;Pedro Lopez-Sanchez;Ivan Rubio-Gayosso
The Korean Journal of Physiology and Pharmacology
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v.27
no.1
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pp.9-20
/
2023
The mechanism is unclear for the reported protective effect of hyperbaric oxygen preconditioning against oxidative stress in tissues, and the distinct effects of hyperbaric oxygen applied after stress. The trained mice were divided into three groups: the control, hyperbaric oxygenation preconditioning, and hyperbaric oxygenation applied after mild (fasting) or hard (prolonged exercise) stress. After preconditioning, we observed a decrease in basal levels of nitric oxide, tetrahydrobiopterin, and catalase despite the drastic increase in inducible and endothelial nitric oxide synthases. Moreover, the basal levels of glutathione, related enzymes, and nitrosative stress only increased in the preconditioning group. The control and preconditioning groups showed a similar mild stress response of the endothelial and neuronal nitric oxide synthases. At the same time, the activity of all nitric oxide synthase, glutathione (GSH) in muscle, declined in the experimental groups but increased in control during hard stress. The results suggested that hyperbaric oxygen preconditioning provoked uncoupling of nitric oxide synthases and the elevated levels of GSH in muscle during this study, while hyperbaric oxygen applied after stress showed a lower level of GSH but higher recovery post-exercise levels in the majority of antioxidant enzymes. We discuss the possible mechanisms of the redox response and the role of the nitric oxide in this process.
Byunghoon Lee;Yong Beom Shin;Kwangha Lee;Myung Hun Jang
Physical Therapy Rehabilitation Science
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v.12
no.1
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pp.43-47
/
2023
Objective: To present a case study of a 69-year-old woman with COVID-19 who developed neurological complications due to Extracorporeal Membrane Oxygenation (ECMO) therapy and highlight the importance of daily neurological examinations and rehabilitation in the early detection and management of ECMO-related neurological complications in an isolation ICU. Design: A case report Methods: The patient received ECMO therapy, followed by neurological monitoring and rehabilitation in an isolation ICU. Daily neurological examinations were conducted to monitor the patient's neurological symptoms. Computed tomography was performed to confirm the presence of a hematoma in the left hamstring, which was identified as the cause of the neurological complication. Ultrasound-guided aspiration was immediately performed, and sciatic neuropathy predominantly involving the peroneal division was identified after aspiration. Results: Successful recovery was made possible by the early detection of neurological complications and rehabilitation in an isolation ICU. Although electrodiagnostic tests were not performed due to limited access to the isolation ICU, the appropriate intervention time could be determined through daily neurological examinations and rehabilitation, thereby minimizing neurological sequelae. Conclusions: ECMO-related neurological complications are well known, and their recognition in the ICU can be challenging. The presented case highlights the importance of daily neurological examinations and rehabilitation in the early detection and management of ECMO-related neurological complications in an isolation ICU, which can minimize neurological sequelae.
Purpose: This study aimed to develop an evidence-based extracorporeal membrane oxygenation (ECMO) nursing protocol for critically ill patients receiving ECMO treatment by using an adaptation process, and to verify the effects of the protocol. Methods: The protocol was developed according to the adaptation guidelines. A non-randomized controlled trial was conducted to test the protocol's effects. Data were collected between April 2019 and March 2021. The differences in physiological indicators and complication rates between the two groups were investigated using a chart review to evaluate patient outcomes. The nurses' outcome variables were evaluated using a questionnaire. Results: First, after reviewing 11 guidelines by appraisal of the guidelines for research and evaluation collaboration II, 5 guidelines with a standardization grade of over 50 points were selected. An ECMO nursing protocol was developed based on these guidelines. Second, there were no statistically significant differences in physiological indicators between the two groups of patients. However, the experimental group showed a statistically significant decrease in the infection rate (p = .026) and pressure injury rates (p = .041). The levels of satisfaction with ECMO nursing care, and empowerment and performance of the nurses who used the ECMO nursing protocol were higher than those of nurses who did not (p < .001). Conclusion: This protocol may help prevent infections and pressure injuries in patients, and improve nurses' satisfaction and empowerment. The nursing protocol developed for critically ill patients receiving ECMO treatment can be utilized in evidence-based nursing practice.
JeongA Son;Seungji Hyun;Woo Sik Yu;Joonho Jung;Seokjin Haam
Journal of Chest Surgery
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v.56
no.2
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pp.128-135
/
2023
Background: Pneumonia caused by severe acute respiratory syndrome coronavirus 2 can cause acute respiratory distress syndrome, often requiring prolonged mechanical ventilation and eventually tracheostomy. Both procedures occur in isolation units where personal protective equipment is needed. Additionally, the high bleeding risk in patients with extracorporeal membrane oxygenation (ECMO) places a great strain on surgeons. We investigated the clinical characteristics and outcomes of percutaneous dilatational tracheostomy (PDT) in patients with coronavirus disease 2019 (COVID-19) supported by ECMO, and compared the outcomes of patients with and without ECMO. Methods: This retrospective, single-center, observational study included patients with severe COVID-19 who underwent elective PDT (n=29) from April 1, 2020, to October 31, 2021. The patients were divided into ECMO and non-ECMO groups. Data were collected from electronic medical records at Ajou University Hospital in Suwon, Korea. Results: Twenty-nine COVID-19 patients underwent PDT (24 men [82.8%] and 5 women [17.2%]; median age, 61 years; range, 26-87 years; interquartile range, 54-71 years). The mean procedure time was 17±10.07 minutes. No clinically or statistically significant difference in procedure time was noted between the ECMO and non-ECMO groups (16.35±7.34 vs. 18.25±13.32, p=0.661). Overall, 12 patients (41.4%) had minor complications; 10 had mild subdermal bleeding from the skin incision, which was resolved with local gauze packing, and 2 (6.9%) had dislodgement. No healthcare provider infection was reported. Conclusion: Our PDT approach is safe for patients and healthcare providers. With bronchoscopy assistance, PDT can be performed quickly and easily even in isolation units and with acceptable risk, regardless of the hypo-coagulable condition of patients on ECMO.
Sahri Kim;Jung Hyun Lim;Ho Hyun Ko;Hong Kyu Lee;Yong Joon Ra;Kunil Kim;Hyoung Soo Kim
Journal of Chest Surgery
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v.57
no.1
/
pp.36-43
/
2024
Background: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory failure, which frequently necessitates invasive mechanical ventilation and extracorporeal membrane oxygenation (ECMO). However, the limited availability of ECMO resources poses challenges to patient selection and associated decision-making. Consequently, this retrospective single-center study was undertaken to evaluate the characteristics and clinical outcomes of patients with COVID-19 receiving ECMO. Methods: Between March 2020 and July 2022, 65 patients with COVID-19 were treated with ECMO and were subsequently reviewed. Patient demographics, laboratory data, and clinical outcomes were examined, and statistical analyses were performed to identify risk factors associated with mortality. Results: Of the patients studied, 15 (23.1%) survived and were discharged from the hospital, while 50 (76.9%) died during their hospitalization. The survival group had a significantly lower median age, at 52 years (interquartile range [IQR], 47.5-61.5 years), compared to 64 years (IQR, 60.0-68.0 years) among mortality group (p=0.016). However, no significant differences were observed in other underlying conditions or in factors related to intervention timing. Multivariable analysis revealed that the requirement of a change in ECMO mode (odds ratio [OR], 366.77; 95% confidence interval [CI], 1.92-69911.92; p=0.0275) and the initiation of continuous renal replacement therapy (CRRT) (OR, 139.15; 95% CI, 1.95-9,910.14; p=0.0233) were independent predictors of mortality. Conclusion: Changes in ECMO mode and the initiation of CRRT during management were associated with mortality in patients with COVID-19 who were supported by ECMO. Patients exhibiting these factors require careful monitoring due to the potential for adverse outcomes.
Sahri Kim;Jung Hyun Lim;Ho Hyun Ko;Lyo Min Kwon;Hong Kyu Lee;Yong Joon Ra;Kunil Kim;Hyoung Soo Kim
Journal of Chest Surgery
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v.57
no.2
/
pp.195-204
/
2024
Background: Extracorporeal membrane oxygenation (ECMO) is an intervention for severe heart and lung failure; however, it poses the risk of complications, including gastrointestinal bleeding (GIB). Comprehensive analyses of GIB in patients undergoing ECMO are limited, and its impact on clinical outcomes remains unclear. Methods: This retrospective study included 484 patients who received venovenous and venoarterial ECMO between January 2015 and December 2022. Data collected included patient characteristics, laboratory results, GIB details, and interventions. Statistical analyses were performed to identify risk factors and assess the outcomes. Results: GIB occurred in 44 of 484 patients (9.1%) who received ECMO. Multivariable analysis revealed that older age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.06; p=0.0130) and need to change the ECMO mode (OR, 3.74; 95% CI, 1.75-7.96; p=0.0006) were significant risk factors for GIB, whereas no association was found with antiplatelet or systemic anticoagulation therapies during ECMO management. Half of the patients with GIB (22/44, 50%) underwent intervention, with endoscopy as the primary modality (19/22, 86.4%). Patients who underwent ECMO and developed GIB had higher rates of mortality (40/44 [90.9%] vs. 262/440 [59.5%]) and ECMO weaning failure (38/44 [86.4%] vs. 208/440 [47.3%]). Conclusion: GIB in patients undergoing ECMO is associated with adverse outcomes, including increased risks of mortality and weaning failure. Even in seemingly uncomplicated cases, it is crucial to avoid underestimating the significance of GIB.
Jeong-Jun Jo;Woo Sung Jang;Namhee Park;Yun Seok Kim;Jae Bum Kim;Kyungsub Song
Journal of Chest Surgery
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v.57
no.4
/
pp.399-407
/
2024
Background: Pump-controlled retrograde trial off (PCRTO) is a safe, simple, and reversible method for weaning patients from veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, few studies have compared PCRTO to conventional weaning methods. This retrospective study aimed to compare PCRTO to non-PCRTO methods. Methods: This study included patients who were weaned from VA-ECMO from January 2016 to December 2022 at our medical center. Demographic data, ECMO management, ECMO complications, survival to discharge, and cardiogenic shock after VA-ECMO weaning were compared between the 2 groups. Results: Seventy patients who were weaned from VA-ECMO using PCRTO and 85 patients who were weaned with conventional methods were compared. Patient characteristics were not significantly different between the 2 groups. The rate of survival to discharge was significantly higher in the PCRTO group than in the non-PCRTO group (90% vs. 72%, p=0.01). The rates of freedom from all-cause mortality at 10, 30, and 50 days after weaning from ECMO were 75%, 55%, and 35% in the non-PCRTO group and 62%, 60%, and 58% in the PCRTO group, respectively (p=0.1). The incidence of cardiogenic shock after weaning from VA-ECMO was significantly higher in the non-PCRTO group (16% vs. 5%, p=0.04). In logistic regression analysis, PCRTO was a significant factor for survival to discharge (odds ratio, 2.42; 95% confidence interval, 1.29-5.28; p=0.02). Conclusion: Compared to conventional methods, PCRTO is a feasible and reversible method, and it serves as a useful predictor of successful VA-ECMO weaning through a preload stress test.
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