Perfusion
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Case Reports
Dynamic left ventricular outflow tract obstruction in apical ballooning syndrome (Takotsubo cardiomyopathy).
Patients with apical ballooning syndrome may develop dynamic left ventricular outflow obstruction due to systolic anterior motion of the mitral valve leaflet and secondary functional mitral regurgitation, causing decreased cardiac output and hypotension. If suspected, bedside echocardiography will quickly confirm this complication. Positive inotropic/chronotropic agents should be avoided as they may exacerbate outflow tract obstruction, resulting in further hemodynamic compromise.
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Extracorporeal membrane oxygenation (ECMO) in patients with severe pulmonary failure is able to keep patients alive until organ regeneration, until shunting out for further diagnostic and therapeutic options or until transportation to specialized centers. Nonetheless, extracorporeal techniques require a high degree of expertise, so that a confinement to specialized centers is meaningful. Following from this requirement, the need for inter-hospital transfer of patients with severely compromised pulmonary function is rising. ⋯ Our experience demonstrates that miniaturized, portable ECMO therapy allows location-independent, out-of-center stabilization of pulmonary compromised patients with consecutive inter-hospital transfer and further in-house treatment, so that sophisticated ECMO therapy can be offered to every patient, even in hospitals with primary healthcare.
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Extracorporeal membrane oxygenation (ECMO) is a means of life support for failing patients who require extreme life-saving measures due to failure of their heart, lungs or both organs. In a patient suffering cardiac arrest, the faster circulation via cardiopulmonary resuscitation (CPR) can be instituted the better the outcome is. If an ECMO circuit needs to be built and primed it may add significant minutes to the response time. ⋯ This, in turn, may lead to decreased response time, with an arrest and the placement of the arresting patient on ECMO. Five ECMO circuits were set up, primed and sampled for bacterial growth at 0, 24, 48 and 72 hours and then at one-week intervals, with an end point of four weeks. No bacterial growth was found at any point during the sampling process.