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Title: First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation
Authors: PARK, MarceloAZEVEDO, Luciano Cesar PontesMENDES, Pedro VitaleCARVALHO, Carlos Roberto RibeiroAMATO, Marcelo Brito PassosSCHETTINO, Guilherme Paula PintoTUCCI, MauroMACIEL, Alexandre ToledoTANIGUCHI, Leandro UtinoBARBOSA, Edzangela Vasconcelos SantosNARDI, Raquel OliveiraIGNACIO, Michelle de NardiMACHTANS, Claudio CerqueiraNEVES, Wellington AlvesHIROTA, Adriana SayuriCOSTA, Eduardo Leite Vieira
Citation: CLINICS, v.67, n.10, p.1157-1163, 2012
Abstract: OBJECTIVES: The aim of this manuscript is to describe the first year of our experience using extracorporeal membrane oxygenation support. METHODS: Ten patients with severe refractory hypoxemia, two with associated severe cardiovascular failure, were supported using venous-venous extracorporeal membrane oxygenation (eight patients) or veno-arterial extracorporeal membrane oxygenation (two patients). RESULTS: The median age of the patients was 31 yr (range 14-71 yr). Their median simplified acute physiological score three (SAPS3) was 94 (range 84-118), and they had a median expected mortality of 95% (range 87-99%). Community-acquired pneumonia was the most common diagnosis (50%), followed by P. jiroveci pneumonia in two patients with AIDS (20%). Six patients were transferred from other ICUs during extracorporeal membrane oxygenation support, three of whom were transferred between ICUs within the hospital (30%), two by ambulance (20%) and one by helicopter (10%). Only one patient (10%) was anticoagulated with heparin throughout extracorporeal membrane oxygenation support. Eighty percent of patients required continuous venous-venous hemofiltration. Three patients (30%) developed persistent hypoxemia, which was corrected using higher positive end-expiratory pressure, higher inspired oxygen fractions, recruitment maneuvers, and nitric oxide. The median time on extracorporeal membrane oxygenation support was five (range 3-32) days. The median length of the hospital stay was 31 (range 3-97) days. Four patients (40%) survived to 60 days, and they were free from renal replacement therapy and oxygen support. CONCLUSIONS: The use of extracorporeal membrane oxygenation support in severely ill patients is possible in the presence of a structured team. Efforts must be made to recognize the necessity of extracorporeal respiratory support at an early stage and to prompt activation of the extracorporeal membrane oxygenation team.
Appears in Collections:

Artigos e Materiais de Revistas Científicas - FM/MCP
Departamento de Cardio-Pneumologia - FM/MCP

Artigos e Materiais de Revistas Científicas - HC/ICHC
Instituto Central - HC/ICHC

Artigos e Materiais de Revistas Científicas - HC/InCor
Instituto do Coração - HC/InCor

Artigos e Materiais de Revistas Científicas - LIM/09
LIM/09 - Laboratório de Pneumologia

Artigos e Materiais de Revistas Científicas - LIM/51
LIM/51 - Laboratório de Emergências Clínicas

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