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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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The implementation of ECMO in cardiac arrest refractory to conventional resuscitation is reliable? Single-center experience
Session:
Posters 1 - Écran 1 - Doença Coronária
Speaker:
Domingas Canga Mbala
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.5 Acute Cardiac Care – Cardiac Arrest
Session Type:
Posters
FP Number:
---
Authors:
Domingas Canga Mbala; Marisa Silva; Daniel Caeiro; Pedro Gonçalves Teixeira; Neusa Guiomar; Eduardo Vilela; Ana Mosalina; João Almeida; Olga Sousa; Adelaide V. Dias; Alberto Rodrigues; Pedro Braga
Abstract
<p><strong><em>Introduction:</em></strong> The implementation of assisted cardiorespiratory resuscitation (CPR) with extracorporal membrane oxygenation (ECMO) of the veno-arterial type at the cardiac arrest refractory to conventional CPR (technically called E-PCR), both intrahospital and extrahospital, has been discussed in several sectors and may turn out to be a promising alternative in specific cases. We aim to review the efficacy and safety of E-PCR in a consecutive series of patients referred to our center. <strong><em>Methods:</em></strong> We performed a retrospective analysis of clinical and technical procedural data of consecutive patients undergoing ECMO during cardiac arrest refractory to conventional resuscitation at our center, between January 2011 and June 2018. <strong><em>Results:</em> </strong> Fifty nine patients underwent ECMO due to refractory cardiogenic shock, of which 15 were implanted during refractory cardiac arrest. Most were referred to our center with a diagnosis of acute myocardial infarction for primary stratification. The mean age was 54.7 (24-68 years); male with 53.3%; the underlying etiology of refractory CPR was acute myocardial infarction (66.7%); the most frequent arrest rhythm was the pulseless electrical activity (46.7%), followed by ventricular fibrillation (33.3%); the mean duration in ECMO was 6.1 days (0 - 23 days); the most frequent cause of death was multiorgan dysfunction, mostly triggered by refractory cardiogenic shock. The history of ischemic heart disease (13.3%), hypertension (53.3%), smoking (40.0%) and dyslipidemia (60.0%) were associated with a lower probability of survival. E-CPR was rapidly implemented by direct cannulation of the right femoral artery in the hemodynamic laboratory by interventionists and intensivists, was admitted to the cardiac intensive care unit, except 33.3% of these were transferred to the operating theater for emergent cardiac surgery due to mechanical prosthesis dysfunction and 6.67% referred for transplantation; 26.7% were discharged; 20% transferred to the multipurpose care unit due to the need for isolation and difficult ventilatory weaning. Technical success was achieved in 15 (100%) of the procedures. Six cases (40%) submitted to renal replacement technique, due to acute or chronic acute renal injury. Vascular surgical intervention was necessary in three cases (20%), which consisted of fasciotomy of the lower limbs due to ischemia. Death during ECMO occurred in 20.0% of cases; weaning occurred in 11 cases (73.3%) and the mean hospitalization time was 6.1 (0-23 days). <strong><em>Conclusions:</em></strong> In in-hospital E-CPR was favorable in terms of technical success, procedural safety and clinical improvement. Handling by intensivist and interventional cardiologists is reliable, it is associated with a relatively high survival rate when deployed early. The procedure is complex, requires a multidisciplinary effort that can lead to favorable results.</p>
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