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Zhao CY, Sheng KJ, Bao T, Shi T, Liu PN, Yan Y, Zheng XL. Commercial and novel anticoagulant ECMO coatings: a review. J Mater Chem B 2023. [PMID: 37183615 DOI: 10.1039/d3tb00471f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is an invasive and last-resort treatment for circulatory and respiratory failure. Prolonged ECMO support can disrupt the coagulation and anticoagulation systems in a patient, leading to adverse consequences, such as bleeding and thrombosis. To address this problem, anticoagulation coatings have been developed for use in ECMO circuits. This article reviews commonly used commercial and novel anticoagulant coatings developed in recent years and proposes a new classification of coatings based on the current state. While commercial coatings have been used clinically for decades, this review focuses on comparing the effectiveness and stability of coatings to support clinical selections. Furthermore, novel anticoagulation coatings often involve complex mechanisms and elaborate design strategies, and this review summarises representative studies on mainstream anticoagulation coatings to provide a point of reference for future studies.
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Affiliation(s)
- Chang-Ying Zhao
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Kang-Jia Sheng
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Tao Bao
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Tao Shi
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Pei-Nan Liu
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Yang Yan
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Xing-Long Zheng
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
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2
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Kimura T, Kobayashi T, Kobori F, Goto M, Takemitsu M, Tanaka A, Sato J, Isomine S. Massive hemoptysis managed by prolonged anticoagulation-free veno-venous extracorporeal membrane oxygenation with which thoracic surgeries were accompanied: a case report. JA Clin Rep 2022; 8:11. [PMID: 35190925 PMCID: PMC8861252 DOI: 10.1186/s40981-022-00503-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 12/29/2022] Open
Abstract
Background Massive hemoptysis causing inadequate ventilation results in life-threatening consequences. We present a patient who developed respiratory insufficiency produced by bronchiectatic massive hemoptysis and underwent prolonged anticoagulation-free veno-venous extracorporeal membrane oxygenation (VV-ECMO) during which thoracic surgeries were performed. Case presentation A 79-year-old woman suffered massive hemoptysis resulting in respiratory failure during fiberoptic bronchoscopy. Bronchial intubation followed by one lung ventilation failed to ensure adequate oxygenation. Anticoagulation-free VV-ECMO, therefore, was installed immediately. Since conservative hemostatic measures including bronchial arterial embolization were not effective, resection of the culprit lung was performed while on VV-ECMO. Next day an exploratory thoracotomy and intercostal artery embolization were needed for recurrent bleeding. The VV-ECMO was withdrawn after five days of operation. Conclusions Massive hemoptysis can be fatal and needs instantaneous and intensive treatments. In our case, long-term anticoagulation-free VV-ECMO during which thoracic surgeries and endovascular interventions were performed provided a favorable outcome.
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3
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Zarragoikoetxea I, Pajares A, Moreno I, Porta J, Koller T, Cegarra V, Gonzalez A, Eiras M, Sandoval E, Sarralde J, Quintana-Villamandos B, Vicente Guillén R. Documento de consenso SEDAR/SECCE sobre el manejo de ECMO. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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4
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Zarragoikoetxea I, Pajares A, Moreno I, Porta J, Koller T, Cegarra V, Gonzalez AI, Eiras M, Sandoval E, Aurelio Sarralde J, Quintana-Villamandos B, Vicente Guillén R. SEDAR/SECCE ECMO management consensus document. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:443-471. [PMID: 34535426 DOI: 10.1016/j.redare.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/14/2020] [Indexed: 06/13/2023]
Abstract
ECMO is an extracorporeal cardiorespiratory support system whose use has been increased in the last decade. Respiratory failure, postcardiotomy shock, and lung or heart primary graft failure may require the use of cardiorespiratory mechanical assistance. In this scenario perioperative medical and surgical management is crucial. Despite the evolution of technology in the area of extracorporeal support, morbidity and mortality of these patients continues to be high, and therefore the indication as well as the ECMO removal should be established within a multidisciplinary team with expertise in the area. This consensus document aims to unify medical knowledge and provides recommendations based on both the recent bibliography and the main national ECMO implantation centres experience with the goal of improving comprehensive patient care.
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Affiliation(s)
- I Zarragoikoetxea
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - A Pajares
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - I Moreno
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J Porta
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - T Koller
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - V Cegarra
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A I Gonzalez
- Servicio de Anestesiología y Reanimación, Hospital Puerta de Hierro, Madrid, Spain
| | - M Eiras
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Santiago, La Coruña, Spain
| | - E Sandoval
- Servicio de Cirugía Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Aurelio Sarralde
- Servicio de Cirugía Cardiovascular, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - B Quintana-Villamandos
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Vicente Guillén
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Breda JR, Aljure O, Sfakianaki AK, Loebe M. Cesarean section in patient with metastatic Ewing sarcoma requiring VA-ECMO support. J Card Surg 2021; 36:4756-4758. [PMID: 34523160 DOI: 10.1111/jocs.15984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
A 26-year-old pregnant woman, with multiple metastatic Ewing sarcoma, presented with a sternal mass that began enlarging during pregnancy. Due to high-risk pregnancy, the patient was discussed in a multidisciplinary meeting and intubation was considered too risky without cardiopulmonary support. Computed tomography showed extrinsic tumor compression of the right ventricle outflow tract. Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) was initiated before general anesthesia, followed by Cesarean section (C-section). VA ECMO was initiated with the patient in the awake position, ECMO support was discontinued when the patient had stable ventilation and hemodynamics. This case represents a unique indication of VA ECMO, during C-section, with maternal and fetal survival.
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Affiliation(s)
- Joao R Breda
- Division of Thoracic Transplantation and Mechanical Support, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Oscar Aljure
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anna K Sfakianaki
- Department of Maternal and Fetal Medicine, Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Matthias Loebe
- Division of Thoracic Transplantation and Mechanical Support, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Kim T, Lee S, Lee S. Relationship between 30 Days Mortality and Incidence of Intraoperative Cardiac Arrest According to the Timing of ECMO. J Clin Med 2021; 10:jcm10091977. [PMID: 34062958 PMCID: PMC8125744 DOI: 10.3390/jcm10091977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Recently, the use of extracorporeal membrane oxygenation (ECMO) in noncardiac surgery, such as thoracic surgery, has increased. However, there have been no studies on the mortality and incidence of intraoperative cardiac arrest with or without ECMO during thoracic surgery. Methods: Between January 2011 and October 2018, 63 patients received ECMO support during thoracic surgery. All patients who applied ECMO from starting at any time before surgery to the day of surgery were included. Patients were divided into the emergency ECMO group and the non-emergency ECMO group according to the timing of ECMO. We compared the factors related to 30 day mortality using Cox regression analysis. Results: The emergency ECMO and non-emergency ECMO groups comprised 27 and 36 patients, respectively. On the operation day, cardiopulmonary resuscitation (CPR) was a very important result, and only occurred in the emergency ECMO group (n = 20, 74.1% vs. 0%, p < 0.001). The most common cause of ECMO indication was the CPR in the emergency ECMO group and respiratory failure in the non-emergency ECMO group. There were significant differences in 30 day mortality between the emergency ECMO group and the non-emergency ECMO group (n = 12, 44.4% vs. n = 3, 8.3%, p = 0.001). The Kaplan–Meier analysis curve for 30 day mortality showed that the emergency ECMO group had a significantly higher rate of 30 day mortality than the non-emergency ECMO group (X2 = 14.7, p < 0.001). Conclusions: A lower incidence of intraoperative cardiac arrest occurred in the non-emergency ECMO group than in the emergency ECMO group. Moreover, 30 day mortality was associated with emergency ECMO.
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Affiliation(s)
- Taehwa Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Gyoungnam, Korea;
| | - Seungeun Lee
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Gyoungnam, Korea;
- Correspondence: (S.L.); (S.L.); Tel.: +82-55-360-2127 (Sungkwang Lee)
| | - Sungkwang Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, Gyoungnam, Korea
- Correspondence: (S.L.); (S.L.); Tel.: +82-55-360-2127 (Sungkwang Lee)
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7
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Al-Thani H, Ahmed K, Rizoli S, Chughtai T, Fawzy I, El-Menyar A. Utility of extracorporeal membrane oxygenation (ECMO) in the management of traumatic tracheobronchial injuries: case series. J Surg Case Rep 2021; 2021:rjab158. [PMID: 33927882 PMCID: PMC8068472 DOI: 10.1093/jscr/rjab158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 12/03/2022] Open
Abstract
Tracheobronchial injury is a rare, but potentially life-threatening condition, and in most cases requires urgent treatment to restore normal respiratory physiology. Over the past decades, extracorporeal membrane oxygenation (ECMO) has evolved as an important adjunct in airway surgery. We presented three cases of traumatic tracheobronchial injury managed with ECMO support at a level-1 trauma center and emphasized the benefits of anticipation and early institution of ECMO support perioperatively, in these high-risk cases. The management of traumatic tracheobronchial injuries requires early measures to guarantee adequate ventilation. Anticipation and early institution of ECMO in these patients may support respiratory physiology, facilitate repair and improve survival. The time factor and multidisciplinary communication and plan prior to intervention should be considered. ECMO support, whenever available, plays important role in the management of complicated tracheobronchial surgical procedure and thereby reduces risk of mortality.
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Affiliation(s)
- Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Khalid Ahmed
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Sandro Rizoli
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Talat Chughtai
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | | | - Ayman El-Menyar
- Clinical Research, Trauma and Vascular Surgery Section, HGH, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
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8
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Brewer JM, Tran A, Yu J, Ali MI, Poulos CM, Gates J, Underhill D, Gluck J. Application and outcomes of extracorporeal life support in emergency general surgery and trauma. Perfusion 2021; 37:575-581. [PMID: 33878977 DOI: 10.1177/02676591211009686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We analyzed the use of Extracorporeal Membranous Oxygenation (ECMO) in acute care surgery patients at our Level-1 trauma center. We hypothesized that this patient population has improved ECMO outcomes. METHODS This was a retrospective analysis of emergency general surgery and trauma patients placed on ECMO between the periods of October 2013 and February 2020. There were 10 surgical and 12 trauma patients studied, who eventually required ECMO support. ECMO support and ECMO type/modality were analyzed with injury and survival prognostic scores examined. MAIN RESULTS Overall, 16 of the 22 patients survived to hospital discharge, for a survival rate of 73%. Mean age was 34.18 years. Mean hospital length of stay was 23.4 days with mean days on ECMO equal to 7.5. The net negative fluid balance was 5.36 L. CONCLUSIONS The survival of our ECMO cohort is notably higher than previously cited studies. Our group demonstrated decreased length of time on ECMO, decreased length of stay in the hospital, and similar rates of complications compared to prior reports. ECMO is a useful modality in acute care surgical patients and should be considered in these patient populations. Our focus on net negative fluid balance for ECMO patients demonstrates improved survival. ECMO should be considered early in surgical patients and early in advanced trauma life support.
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Affiliation(s)
- Jennifer M Brewer
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - Anthony Tran
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - Jielin Yu
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - M Irfan Ali
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - C M Poulos
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - Jonathan Gates
- Division of Trauma and Acute Care Surgery, Hartford Healthcare, Hartford, CT, USA
| | - David Underhill
- Division of Cardiac Surgery, Hartford Healthcare, Hartford, CT, USA
| | - Jason Gluck
- Department of Cardiology and Mechanical Circulatory Support, Hartford Healthcare, Hartford, CT, USA
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Leow L, Sampath HK, Yong KJ, Kofidis T, Tam JKC, MacLaren G, Teo L, Mithiran H, Ramanathan K. Rescue extracorporeal membrane oxygenation for massive anterior mediastinal masses. J Artif Organs 2021; 24:450-457. [PMID: 33811592 PMCID: PMC8019298 DOI: 10.1007/s10047-021-01264-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/25/2021] [Indexed: 12/17/2022]
Abstract
The management of massive anterior mediastinal masses (AMM) is challenging. With the burgeoning role of extracorporeal membrane oxygenation support (ECMO) beyond the confines of salvage therapy, more trained clinicians are adopting it as a bridge for high-risk procedures or situations where temporary respiratory or cardiac support is required. We report our experience with using ECMO in the management of massive AMM in this case series of three patients sharing their clinical details and the lessons learned from them.
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Affiliation(s)
- Lowell Leow
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Hari Kumar Sampath
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Keith J Yong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Theo Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - John Kit Chung Tam
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Graeme MacLaren
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Lynette Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Harish Mithiran
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Kollengode Ramanathan
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
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Shallik N, Elarref M, Khamash O, Abdelaal A, Radi Alkhafaji M, Makki H, Abusabeib A, Moustafa A, Menon A. Management of critical tracheal stenosis with a straw sized tube (Tritube): Case report. Qatar Med J 2021; 2020:48. [PMID: 33598418 PMCID: PMC7842837 DOI: 10.5339/qmj.2020.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/06/2020] [Indexed: 11/24/2022] Open
Abstract
Imminent upper airway obstruction due to life-threatening tracheal stenosis of any cause is a challenging situation. We present a challenging case of total thyroidectomy for a malignant, invasive, and highly vascularized thyroid carcinoma that has invaded the surrounding tissues, including the sternum and mediastinum, resulting in compression of the trachea with indentation. The patient presented with a significant symptomatic tracheal stenosis, the narrowest area of that was 4 mm. Airway management in such cases presents a particular challenge to the anesthesiologists, especially considering that the option of tracheostomy is very difficult most of the time due to the highly swollen thyroid and distorted anatomy. A meticulous history of the patient's illness had been taken, and a comprehensive preoperative evaluation was conducted, including construction of a 3D model airway, virtual endoscopy, and transnasal tracheoscopy. On the day of the surgery, the airway was managed through spontaneous respiration using intravenous anesthesia and the high-flow nasal oxygen (STRIVE-Hi) technique. It was then secured with intubation using a straw endotracheal tube (Tritube®) with an internal diameter (ID) of 2.4 mm and an outer diameter of 4.4 mm with the help of a fiberscope and D-MAC blade of a video laryngoscope. At the end of the procedure, the airway was checked with a fiber optic scope, which showed an improvement in the narrowed area. This enabled us to replace the Tritube with an adult cuffed ETT of size 6.5 mm ID, and the patient was transferred intubated to the surgical ICU. Two days later, the patient's tracheal diameter was evaluated with the help of a fiberoptic scope and extubated successfully in the operating theater.
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Affiliation(s)
| | | | - Odai Khamash
- Hamad Medical Corporation, Anesthesia, ICU and Perioperative Medicine Department, P.O. Box. 3050, Doha, Qatar, E-mail:
| | | | | | | | | | - Abbas Moustafa
- Hamad Medical Corporation, Clinical Radiology and Medical Imaging Department, P.O. Box. 3050, Doha, Qatar
| | - Abhishek Menon
- Hamad Medical Corporation, ENT - ORL Department, P.O. Box. 3050, Doha, Qatar
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Augoustides JG. Cardiopulmonary Resuscitation During the Coronavirus Crisis: Important Updates for the Cardiothoracic and Vascular Anesthesia Community. J Cardiothorac Vasc Anesth 2020; 34:2312-2314. [PMID: 32434725 PMCID: PMC7187853 DOI: 10.1053/j.jvca.2020.04.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 12/20/2022]
Affiliation(s)
- John G Augoustides
- Cardiovascular and Thoracic Section Department of Anesthesiology and Critical Care Perelman School of Medicine University of Pennsylvania Philadelphia, PA.
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12
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Kovar AJ, Olsen J, Augoustides JG. Advanced Cardiovascular Life Support: Focus on Airway Management, Vasopressor Selection, and Rescue Therapy with Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2020; 34:2015-2018. [DOI: 10.1053/j.jvca.2020.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 01/22/2023]
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