Pub Date : 2019-05-03DOI: 10.5772/INTECHOPEN.84771
A. Hessheimer, C. Fondevila
Normothermic regional perfusion (NRP) is used to restore the flow of oxygenated blood following cardiac arrest and reverse warm ischemic injury in donation after circulatory death (DCD) organ transplantation. The use of NRP in this setting has typically been limited to the abdominal cavity, though its use has recently been expanded to chest to help recover DCD hearts, as well. This chapter evaluates the principles behind the use of NRP in DCD organ transplantation as well as not only technical but also ethical and legal aspects associated with its application and the clinical results that have been achieved to date when it has been used to recover various solid organs through the DCD process.
{"title":"Normothermic Regional Perfusion in Solid Organ Transplantation","authors":"A. Hessheimer, C. Fondevila","doi":"10.5772/INTECHOPEN.84771","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.84771","url":null,"abstract":"Normothermic regional perfusion (NRP) is used to restore the flow of oxygenated blood following cardiac arrest and reverse warm ischemic injury in donation after circulatory death (DCD) organ transplantation. The use of NRP in this setting has typically been limited to the abdominal cavity, though its use has recently been expanded to chest to help recover DCD hearts, as well. This chapter evaluates the principles behind the use of NRP in DCD organ transplantation as well as not only technical but also ethical and legal aspects associated with its application and the clinical results that have been achieved to date when it has been used to recover various solid organs through the DCD process.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134420088","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}
Pub Date : 2019-03-20DOI: 10.5772/INTECHOPEN.85047
L. Tritapepe, E. Greco, C. Gaudio
Extracorporeal membrane oxygenation (ECMO) is a special form of organ support for selected cases of cardiovascular and severe respiratory failure. Echocardiography is a diagnostic and monitoring tool widely used in all aspects of ECMO support. The pathophysiology of ECMO, and its distinct effects on cardiorespiratory physiology, requires an echocardiographer with high skills to understand the interaction between the ECMO and the patient. In this chapter, we present the main application of echocardiography in ECMO patients and some general concepts on the ECMO working. ECMO, such as the standard cardiopulmonary bypass employed in cardiac surgery, V-V (veno-venous), can support the insufficient respiratory system by oxygenating and removing carbon dioxide from the blood. VA-ECMO (venous-arterial) can support haemodynamics by providing mechanical circulatory assistance. Today, ECMO can be used as bridge to decision, waiting for the development of the clinical conditions to support with other devices the evolution of cardiorespiratory failure or stop the assistance. Echocardiography (trans-thoracic (TTE) or transoesophageal (TOE)) can be used primarily to take decisions regarding appropriateness of ECMO support, therefore to control cannula insertion and confirm final position, to modify number and position of the cannulae in case of malfunctioning of these, and, finally, to assess clinical progress and suitability for weaning from ECMO.
{"title":"Echocardiography Evaluation in ECMO Patients","authors":"L. Tritapepe, E. Greco, C. Gaudio","doi":"10.5772/INTECHOPEN.85047","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85047","url":null,"abstract":"Extracorporeal membrane oxygenation (ECMO) is a special form of organ support for selected cases of cardiovascular and severe respiratory failure. Echocardiography is a diagnostic and monitoring tool widely used in all aspects of ECMO support. The pathophysiology of ECMO, and its distinct effects on cardiorespiratory physiology, requires an echocardiographer with high skills to understand the interaction between the ECMO and the patient. In this chapter, we present the main application of echocardiography in ECMO patients and some general concepts on the ECMO working. ECMO, such as the standard cardiopulmonary bypass employed in cardiac surgery, V-V (veno-venous), can support the insufficient respiratory system by oxygenating and removing carbon dioxide from the blood. VA-ECMO (venous-arterial) can support haemodynamics by providing mechanical circulatory assistance. Today, ECMO can be used as bridge to decision, waiting for the development of the clinical conditions to support with other devices the evolution of cardiorespiratory failure or stop the assistance. Echocardiography (trans-thoracic (TTE) or transoesophageal (TOE)) can be used primarily to take decisions regarding appropriateness of ECMO support, therefore to control cannula insertion and confirm final position, to modify number and position of the cannulae in case of malfunctioning of these, and, finally, to assess clinical progress and suitability for weaning from ECMO.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125873749","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}
Pub Date : 2019-03-14DOI: 10.5772/INTECHOPEN.85103
Venessa L. Pinto
Extracorporeal membrane oxygenation is challenged by several potential complications. Adverse neurologic events such as intracranial hemorrhages, strokes, seizures, and brain death are among the most detrimental and even catastrophic of ECMO complications. There are several risk factors related to the patients, their underlying conditions and the therapy itself that predispose these patients to neurologic injuries. In this chapter, we review different types of neurological complications, the identification and management of which can be difficult. We will also discuss some of the currently available technologies for multimodal neurological monitoring as a complement to clinical exam.
{"title":"Neurologic Complications and Neuromonitoring on ECMO","authors":"Venessa L. Pinto","doi":"10.5772/INTECHOPEN.85103","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85103","url":null,"abstract":"Extracorporeal membrane oxygenation is challenged by several potential complications. Adverse neurologic events such as intracranial hemorrhages, strokes, seizures, and brain death are among the most detrimental and even catastrophic of ECMO complications. There are several risk factors related to the patients, their underlying conditions and the therapy itself that predispose these patients to neurologic injuries. In this chapter, we review different types of neurological complications, the identification and management of which can be difficult. We will also discuss some of the currently available technologies for multimodal neurological monitoring as a complement to clinical exam.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"184 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127059018","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}
Pub Date : 2019-03-11DOI: 10.5772/INTECHOPEN.83833
M. Mazzei, Suresh Keshavamurthy, Y. Toyoda
Lung transplantation has become an increasingly important modality for the treatment of severe lung disease. From its inception, the procedure has been refined so that it now represents the standard of care for end stage respiratory failure. The widespread adoption of this treatment option, however, has brought into sharp relief the current organ donor shortage. In tandem with the explosion in lung transplant procedures, a number of support modalities have seen an expanded role. Perhaps one of the most versatile tools in the armamentarium of the pulmonary transplant surgeon is extracorporeal membrane oxygenation (ECMO). This powerful tool is being increasingly implemented in all stages of lung transplantation— from supporting the failing native organ as a bridging tool to transplantation, to stabilizing the patient intra-operatively during the transplant procedure, to rescuing the patient with severe primary graft dysfunction immediately post-transplant. A number of advanced techniques for the application of ECMO in order to optimize the pulmonary transplant procedure are gaining traction—and with ECMO’s expanded role in lung transplantation, so also has come a new set of technical and ethical challenges that must also be overcome.
{"title":"Advances in Extracorporeal Membrane Oxygenation in the Setting of Lung Transplantation","authors":"M. Mazzei, Suresh Keshavamurthy, Y. Toyoda","doi":"10.5772/INTECHOPEN.83833","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.83833","url":null,"abstract":"Lung transplantation has become an increasingly important modality for the treatment of severe lung disease. From its inception, the procedure has been refined so that it now represents the standard of care for end stage respiratory failure. The widespread adoption of this treatment option, however, has brought into sharp relief the current organ donor shortage. In tandem with the explosion in lung transplant procedures, a number of support modalities have seen an expanded role. Perhaps one of the most versatile tools in the armamentarium of the pulmonary transplant surgeon is extracorporeal membrane oxygenation (ECMO). This powerful tool is being increasingly implemented in all stages of lung transplantation— from supporting the failing native organ as a bridging tool to transplantation, to stabilizing the patient intra-operatively during the transplant procedure, to rescuing the patient with severe primary graft dysfunction immediately post-transplant. A number of advanced techniques for the application of ECMO in order to optimize the pulmonary transplant procedure are gaining traction—and with ECMO’s expanded role in lung transplantation, so also has come a new set of technical and ethical challenges that must also be overcome.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127803539","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}
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