EKMO Yönetimi

ecmo-kapak

Prof. Dr. Orhan Kemal SALİH
Çukurova Üniversitesi Tıp Fakültesi, Kalp ve Damar Cerrahisi AD, Adana

Özet

Ekstrakorporal membran oksijenizasyonu (EKMO), bilinen tedavilere yanıt vermeyen kalp yetmezliği olan hastalarda dolaşımı desteklemek amacıyla giderek artan şekilde kullanılmaktadır. Konjenital kalp hastalığı, kardiyak arrest, kardiyoje-nik şok, kardiyomiyopati, miyokardit ve çeşitli sebepler nedeni ile EKMO uygulan-mış hastalarda istatistikler yaşam oranını %23-71 olarak vermektedir. EKMO uygu-lanan hastada antikoagülasyon EKMO uzmanları tarafından yönetilmelidir. Erişkin ve pediatrik kardiyak EKMO yönetimi arasındaki farklar iyi bilinmelidir. Güvenli ve başarılı bir şekilde EKMO uygulanabilmesi için aşırı özen, uzmanlık, uzun dönem klinik bakım ve sabır gerekmektedir. Hasta seçimi hem hastanın durumuna hem de bu işi yapacak ekibin ve kliniğin yeterliliğine bağlıdır. Hastanın hayatta kalması için erken konsültasyon, nakil ve uzman ekip çok önemlidir. İdeal olan, EKMO’nun deneyimli merkezlerde uygulanmasıdır.

Referanslar

  1. Foley DS, Swaniker F, Pranikoff T, Bartlett RH, Hirschl R. Percutaneous cannulation for pediatric venovenous extra-corporeal life support. J Pediatr Surg 2000;35(6):943-7.
  2. Miskulin J, Annich G, Grams R, et al. Venous-arteriovenous cannulation for adult ECMO patients with cardiogenic shock. 14th Annual ELSO Conference, September 10-12, 2004, Chicago, IL.
  3. Havel M, Grabenwöger F, Schneider J, Laufer G, Wollenek G, Owen A, et al. Aprotinin does not decrease early graft patency after coronary artery bypass grafting despite reducing postoperative bleeding and use of donated blood. Tho-rac Cardiovasc Surg 1994;107(3):807-10.
  4. CrossRef; Plötz FB, Oeveren W, van Bartlett RH, Wildevuur ChRH. Blood activation during neonatal extracorporeal life support ( ECLS). Perfusion 1992;7:27-33.
  5. Plötz FB, van Oeveren W, Aloe LS, Riley MK, Hultquist KA, Bartlett RH, et al. Prophylactic administration of trane-xamic acid preserves platelet numbers during extracorporeal circulation in rabbits. ASAIO Trans 1991;37(3):M416-7
  6. Dalton HJ, Siewers RD, Fuhrman BP, Del Nido P, Thompson AE, Shaver MG, et al. Extracorporeal membrane oxy-genation for cardiac rescue in children with severe myocardial dysfunction. Crit Care Med 1993;21(7):1020-8.
  7. Sivarajan VB, Best D, Brizard CP, Shekerdemian LS, d'Udekem Y, Butt W. Duration of resuscitation prior to rescue extracorporeal membrane oxygenation impacts outcome in children with heart disease. Intensive Care Med 2011;37(5):853-60.
  8. Edmunds LH Jr, Colman RW. Extracorporeal Circulation: Thrombosis and Bleeding. In: Cohn LH, Edmunds LH Jr, eds. Cardiac Surgery in the Adult. New York: McGraw-Hill; 2003. p.338-48.
  9. Plötz FB, van Oeveren W, Bartlett RH, Wildevuur CR. Blood activation during neonatal extracorporeal life support. J Thorac Cardiovasc Surg 1993;105(5):823-32.
  10. Leverett LB, Hellums JD, Alfrey CP, Lynch EC. Red blood cell damage by shear stress. Biophys J 1972;12(3):257-73.
  11. Lubowitz H, Harris F, Mehrjardi MH, Sutera SP. Shear-induced changes in permeability of human RBC to sodium. Trans Am Soc Artif Intern Organs 1974;20 B:470-3.
  12. Boedy RF, Howell CG, Kanto WP Jr. Hidden mortality rate associated with extracorporeal membrane oxygenation. J Pediatr 1990;117(3):462-4.
  13. Hilt T, Graves DF, Chernin JM, Angel CA, Herndon DN, Zwischenberger JB. Successful use of extracorporeal mem-brane oxygenation to treat severe respiratory failure in a pediatric patient with a scald injury. Crit Care Nurse 1998;18(6):63-72.
  14. Jonas RA. Comprehensive Surgical Management of Congenital Heart Disease. Journal Article, Jonas RA, Wypij D, Roth SJ, Bellinger DC. 2004.
  15. Di Russo GB, Martin GR. Extracorporeal membrane oxygenation for cardiac disease: no longer a mistaken diagno-sis. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005:34-40.
  16. Aiyagari RM, Rocchini AP, Remenapp RT, Graziano JN. Decompression of the left atrium during extracorporeal mem-brane oxygenation using a transseptal cannula incorporated into the circuit. Crit Care Med 2006;34(10):2603-6.
  17. Kuhlen R, Rossaint R. Die Intensivtherapie bei akutem Lungenversagen. Steinkopff 2003.
  18. Andropoulos DB, Heard MB, Johnson KL, Clarke JT, Rowe RW. Postanesthetic apnea in full-term infants after pylo-romyotomy. Anesthesiology 1994;80(1):216-9.
  19. atz A. C., Niles D., Hanna B. D., Eilevstionn J., Jones G., Lombardi K., Diaz L. K., Gillespie M. J., Rome J. J., Mad-karni V. M.: Sternal Wall Pressure Comparable to Leaning During CPR Impacts Intrathoracic Pressure and He-modynamics in Anesthetized Children during Cardiac Catheterization. Society of Critical Care Medicine poster presentation January 2011.
  20. Pizarro C, Mroczek T, Gidding SS, Murphy JD, Norwood WI. Fontan completion in infants. Ann Thorac Surg 2006;81(6):2243-8.
  21. Wittenstein B, Ng C, Ravn H, Goldman A. Recombinant factor VII for severe bleeding during extracorporeal membrane oxygenation following open heart surgery. Pediatr Crit Care Med 2005;6(4):473-6.
  22. Duncan BW, Ibrahim AE, Hraska V, del Nido PJ, Laussen PC, Wessel DL, et al. Use of rapid-deployment extracor-poreal membrane oxygenation for the resuscitation of pediatric patients with heart disease after cardiac arrest. J Tho-rac Cardiovasc Surg 1998;116(2):305-11.
  23. Kornhauser MS, Baumgart S, Desai SA, Stanley CW, Culhane J, Cullen JA, et al. Adverse neurodevelopmental out-come after extracorporeal membrane oxygenation among neonates with bronchopulmonary dysplasia. J Pediatr 1998;132(2):307-11.
  24. Franco KL, Verrier ED. Medical Secker-Walker JS, Edmonds JF, Spratt EH, Conn AW. The source of coronary per-fusion during partial bypass for extracorporeal membrane oxygenation (ECMO). 2003.