Egyptian Journal of Critical Care Medicine最新文献

Extracorporeal Membrane Oxygenation (ECMO) is a lifesaving procedure developed for the care of patients with short-term respiratory and/or cardiac issues (MacLaren et al., 2011). ECMO patients must be monitored twenty-four hours a day by an ECMO-trained multidisciplinary team. The trained healthcare professional needs to watch over fifty variables and rapidly intervene to assess and resolve any given emergency. Hence hands on training is very important for ECMO professionals to develop rapid and correct actions upon different scenarios. Simulation based training (SBT) offers ECMO practitioners an opportunity to develop the skills needed for the initiation of the ECMO procedure and the care of ECMO patients without exposing patients to undue risks (Al Disi et al., 2018). For ECMO to work, cannulation is required to reroute the blood flow to the machine rather than the lung and/or heart. Cannulation is the insertion of a cannula through the blood vessels. In collaboration with Hamad Medical Corporation (HMC), the main healthcare provider in Qatar, the aim of this project is to develop an effective, economical realistic, user-friendly, low-cost, and a multi-functional high-fidelity cannulation simulation mannequin.

Pheochromocytoma is a rare neuroendocrine tumors which overproduce catecholamines and arise from the adrenal gland or extra-adrenal chromaffin cells of the sympathetic and parasympathetic ganglia. We report a case of pheochromocytoma-induced inverted Takotsubo-like cardiomyopathy leading to cardiogenic shock successfully managed with veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) as a bridge to pharmacological control and subsequent curative laparoscopic adrenalectomy.

ECMO supports life in the total absence of lung function. Some patients with apparently irreversible lung injury recover completely after months of ECMO support. New research is intended to determine why this occurs, how often it occurs, and how to predict and initiate lung recovery. This is a new era in lung regenerative biology.

Infants presenting for late arterial switch operation are at risk of myocardial depression and cardiac arrest due left ventricle deconditioning. In this report we present a female infant diagnosed to have transposition of great arteries (TGA) with intact septum who presented at 3 months of age for late arterial switch operation. Prior to surgery, the left ventricle size and mass index appeared to be satisfactory in term of muscular size and function. She underwent late arterial switch operation (ASO). Soon after surgery, the infant developed myocardial depression with hemodynamic instability and high left atrial pressure associated with left atrial dilatation. ECMO was deployed and patient stayed 10 days on ECMO until left cardiac function recovered. The infant was decannulated successfully and was subsequently discharged home with acceptable cardiac function.

In conclusion, patients presenting for late arterial switch operation are at risk for left ventricular deconditioning and pulmonary hypertension. Deconditioned left ventricle may fail post repair with inability to handle systemic circulation. Among limited options for these challenging cases primary ASO with integrated ECMO support can be used to allow deconditioned left ventricle to recover its function and ability to handle systemic circulation.

Acute severe poisoning may lead to life threatening situation or death due to cardiovascular dysfunction or stunning, arrhythmia or cardiogenic shock. These substances include medications, substances used for addiction, house hold chemicals, industrial, plants and animal or vegetable toxicants. The poison profile varies in different parts of world; drugs with cardiotoxic potential are the common poisoning substances while pesticides and other house hold toxins are common in the other part of the world. Irrespective of the type of the poison, these patients are relatively young and usually healthy. Extracorporeal Life Support (ECLS) has become popular in the management of acute severe intoxication induced cardiogenic shock, arrhythmia or cardiac arrest as bridge therapy. The management of poisoning include further reduction of absorption or enhancing the elimination; antidote administration (if available); and supportive therapies including resuscitation. ECMO helps in maintaining adequate cardiac output and tissue perfusion and enhances the toxic substance metabolism. However most of the available literature is based on case reports, case series and retrospective cohort study. In spite of high mortality with severe poisoning and encouraging outcome with use of ECMO, it is underutilized modality across the world. The available literature shows a favourable outcome with ECMO in severely intoxicated patients with cardiovascular collapse, however, there are no clear guidelines for the time of initiation of ECMO on the basis of clinical, metabolic and echocardiographic parameters. Even prognostication prior to initiation of ECMO is difficult to predict. ELSO (Extracorporeal Life Support Organization) may support the global data collection on acute intoxication requiring ECMO, which may address some of these issues.

Extracorporeal life support (ECLS) is an effective therapy used for patients who are severely hypoxic as well as those with cardiogenic shock. Many of these patients require continuous renal replacement therapy (CRRT) as they are too unstable for intermittent haemodialysis. Prognosis of patients who are on ECMO tends to do worse if they develop acute renal failure during the ECMO run resulting in the requirement for dialysis. According to the ELSO registry, the mortality of patients requiring renal replacement therapy (RRT) on ECLS is increased. There are various ways to connect a CRRT circuit onto an ECMO circuit. Each method has its advantages and disadvantages. Separate access for CRRT is recommended.

Dengue is endemic disease in India and tropical countries. It has a wide spectrum of presentation varying from asymptomatic to manifest as undifferentiated fever, dengue fever, dengue shock syndrome or dengue haemorrhagic fever. An increasing number of cases of dengue are being reported with atypical presentations such as dengue encephalitis, secondary bacterial infections, pericardial effusion, myocarditis, cardiac rhythm disturbances like supraventricular tachycardia, conduction block etc.

Dengue is caused by RNA virus of flaviviridae group and has four serotypes- DENV 1–4. Of these type, type 2 (DENV-2) is associated with unusual manifestations of dengue like myocarditis [1], [2]. Early identification and prompt treatment of these uncommon presentations improves the outcome as these complications are temporary and reversible manifestations.

Here we report case of severe myocarditis in dengue with complete recovery following ECMO support.

Diseases prevalent in tropics present with varied manifestations compared to diseases that occur commonly in the temperate climate (the West). Tropical diseases contribute to significant mortality and morbidity. If diagnosed at the right time, tropical diseases have good prognosis too. Utilizing the useful function of supporting the cardio-pulmonary status in these critically ill disease states would be very useful to save thousands of lives each year. As these diseases are not frequent in the West, apart from reporting the experiences in the form of an anecdotal case report, much guidance is not available in their management.