Book contents
- Frontmatter
- Contents
- Introduction
- 1 Hypothermia as a Disorder
- 2 Epidemiology and Estimating Preventable Deaths in Accidental Hypothermia
- 3 Facts and Myths about Hypothermia and its Treatment
- 4 Measurement of Patient's Body Temperature
- 5 Prehospital Management of Hypothermia
- 6 Thermal Insulation
- 7 Airway Management in Hypothermic Patients
- 8 ECG in Hypothermia
- 9 Hypothermia as a Reversible Cause of Cardiac Arrest
- 10 The Role and Tasks of Polish Medical Air Rescue
- 11 Trauma and Hypothermia
- 12 Prehospital Management of Avalanche Victims
- 13 Prehospital Rewarming in Hypothermia. Indications, Methods, Problems and Pitfalls
- 14 Coagulopathies in Hypothermic Patient
- 15 Changes of Pharmacokinetics and Pharmacodynamics of Medications in Hypothermic Patients
- 16 Extracorporeal Therapy in Patients in Severe Hypothermia
- 17 Vascular Access for Extracorporeal Circulation
- 18 Problems and Pitfalls of Qualification for Extracorporeal Treatment of Patients in Severe Hypothermia
- 19 Procedure of Extracorporeal Treatment of Hypothermic Patients
- 20 Recommendation of National Consultant in the Field on Emergency Medicine
- 21 Accidental Hypothermia: the Need for the International Hypothermia Registry
- 22 Qualification for Extracorporeal Rewarming Medical Report
16 - Extracorporeal Therapy in Patients in Severe Hypothermia
Published online by Cambridge University Press: 03 January 2018
- Frontmatter
- Contents
- Introduction
- 1 Hypothermia as a Disorder
- 2 Epidemiology and Estimating Preventable Deaths in Accidental Hypothermia
- 3 Facts and Myths about Hypothermia and its Treatment
- 4 Measurement of Patient's Body Temperature
- 5 Prehospital Management of Hypothermia
- 6 Thermal Insulation
- 7 Airway Management in Hypothermic Patients
- 8 ECG in Hypothermia
- 9 Hypothermia as a Reversible Cause of Cardiac Arrest
- 10 The Role and Tasks of Polish Medical Air Rescue
- 11 Trauma and Hypothermia
- 12 Prehospital Management of Avalanche Victims
- 13 Prehospital Rewarming in Hypothermia. Indications, Methods, Problems and Pitfalls
- 14 Coagulopathies in Hypothermic Patient
- 15 Changes of Pharmacokinetics and Pharmacodynamics of Medications in Hypothermic Patients
- 16 Extracorporeal Therapy in Patients in Severe Hypothermia
- 17 Vascular Access for Extracorporeal Circulation
- 18 Problems and Pitfalls of Qualification for Extracorporeal Treatment of Patients in Severe Hypothermia
- 19 Procedure of Extracorporeal Treatment of Hypothermic Patients
- 20 Recommendation of National Consultant in the Field on Emergency Medicine
- 21 Accidental Hypothermia: the Need for the International Hypothermia Registry
- 22 Qualification for Extracorporeal Rewarming Medical Report
Summary
Introduction
Fast pace of technology advancement, which has been observed since the beginning of 21st century, gives at the disposal of therapeutic teams possibilities which had been practiced priorly only in selected, highly specialised medical centres. Exhaustion of pharmacological means of treatment of acute and end-stage circulatory failure has pointed the attention of the researchers to use of mechanical support and replacement of heart function also outside of specialised cardiac surgery centres, i.e. in other medical facilities, such as emergency care wards. System of extracorporeal membrane oxygenation (ECMO) is currently implemented for various indications.
The most important of them are:
• cardiac indications resulting from myocardial heart failure;
• pulmonary indications resulting from pulmonary failure;
• other indications (severe hypothermia, poisonings, septic shock et al.);
• organ transplantation indications (support of organs functions).
In this paper I would like to present basic ECMO principles and uses, along with applications in emergency care.
History of ECMO use
The first application of extracorporeal circulation during cardiac surgery was described by Gibbon in 1953. Unfortunately, the device used then was unable to operate for longer than 6 hours. In 1971 Hill reported on three- -day-long treatment of a patient in acute respiratory distress syndrome (ARDS), what made the method popular in treatment of patients with lung damage. The genuine breakthrough in extracorporeal blood oxygenation was the establishment of Extracorporeal Life Support Organization (ELSO) in New Orleans, monitoring and coordinating the development of this method in various medical centres. Large multi-centre, randomised trial (CESAR), published in 2009, has shown a substantial reduction of fatality rate among patients with ARDS treated with ECMO in veno-venous configuration. H1N1 influenza pandemic has made medical professionals and decision-makers aware of the necessity to further develop the technology. ECMO in veno-arterial configuration is currently used for treatment of circulatory failure of different aetiology. It should be remembered that the usage of ECMO is practiced in a patient group distinguished by almost 100% fatality rate. According to ELSO report the number of ECMO usages in almost 300 centres cooperating with the organisation has exceeded 50,000 in 2012.
- Type
- Chapter
- Information
- Hypothermia: Clinical Aspects Of Body CoolingAnalysis Of Dangers Directions Of Modern Treatment, pp. 145 - 154Publisher: Jagiellonian University PressPrint publication year: 2016