Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) and the Spanish Society of Pediatric Intensive Care (SECIP) consensus recommendations for ECMO transport

The evolution of extracorporeal membrane oxygenation treatment and the transport of patients receiving this treatment has changed dramatically in the last decade unevenly in different regions. The creation of specialized referral centers has been shown to improve outcomes. For all these reasons, it has been necessary to create networks of specialized teams and the number of secondary transports of patients with this treatment is increasing. In order to improve the quality of treatment and offer a guide to the services involved in these transports, the critical transport working groups of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) and the Spanish Society of Pediatric Intensive Care (SECIP) have carried out a joint effort to prepare these recommendations, focused on the following aspects: indications, reference center systems, means of transport, characteristics and equipment, human teams, training and clinical safety.

[Correlation between optic nerve sheath diameter and extracorporeal life support time]

INTRODUCTION

The objective of the study was to analyse the correlation between extracorporeal life support (ECLS) and aortic cross-clamp times and optic nerve sheath diameter (ONSD).

PATIENTS AND METHODS

Study in a cohort of patients aged 0 to 15 years that underwent ECLS for cardiac surgery after obtention of signed informed consent. We calculated a sample size of 23 participants. First, we obtained 3 vertical and 3 horizontal measurements of the ONSD for each eye and calculated the mean of both eyes for each measurement to be used in the analysis. The measurements were made at admission and at 6 and 24hours post surgery. We retrieved the ECLS time and the aortic cross-clamp time were from the operative report.

RESULTS

We analysed data for 23 participants, 52.2% female, with a median age of 14 months. The median ECLS time was 60minutes; the median aortic cross-clamp time was 32minutes. The median baseline ONSD was 3.1mm. ONSD values had increased a median of 0.015mm at 6hours post surgery (P=.03). We found a positive correlation between ECLS time and ONSD values (r=0.476, p<,05). The ONSD values returned to baseline by 24hours post surgery. None of the patients developed signs or symptoms of increased intracranial pressure.

CONCLUSION

Our study found a correlation between ECLS time and ONSD at 24hours post surgery. We found variations in the ONSD even in patients without signs or symptoms of increased increased intracranial pressure. Further research is required to identify the factors related to these variations.

[Peripheral circulatory support in acute poisoning: 10 years' experience]

Extracorporeal life support (ECLS) has become a common technique for treating refractory cardiogenic shock and cardiac arrest induced by drug overdose. The aim of this paper is to present our group's 10-year experience (2002-2012) using ECLS to treat drug-induced, refractory cardiogenic shock and cardiac arrest. We review 112 consecutive cases of acute poisoning requiring arteriovenous ECLS. We provided ECLS with a Rotaflow pump (Jostra-Maquette). In 71 cases (63%) the patient presented with refractory cardiac arrest; 41 (37%) presented with refractory cardiogenic shock. The dose ingested was very high in all cases. Survival was strongly related to presentation (cardiogenic shock vs cardiac arrest) and the type of drug taken. Survival was highest after overdoses of β-blockers and antiarrhythmic drugs and lowest after overdoses of chloroquine, colchicine, or verapamil. Survival rates were very low in the subgroup of patients presenting with cardiac arrest who had taken hypnotics or sedatives, suggesting that the heart stopped more because of anoxia than because of a direct cardiotoxic effect. In contrast, in cardiotoxic drug-induced cardiac arrest, the survival rate of 10% was significantly higher than the rate in non cardiotoxic arrests. Survival rates in drug-induced cardiogenic shock ranged from 45% to 100%. We conclude that ECLS should be considered for the management of cardiotoxic drug overdose. Close cardiovascular monitoring should be initiated if a patient has taken a particularly high dose of a cardiotoxic drug. Severe cardiotoxicity is rare but life threatening. The use of ECLS in these cases should be based on clinical criteria. Early use of ECLS in drug-induced cardiogenic shock significantly improves survival. Delays in applying ECLS in severe drug-induced cardiotoxicity-diagnosed based on type of drug, dose, and hemodynamic effects-can lead to cardiac arrest and a worse outcome.