A 20-year experience with urgent percutaneous cardiopulmonary bypass for salvage of potential survivors of refractory cardiovascular collapse

In-hospital cardiac arrest or refractory shock carries a high mortality despite the use of advanced resuscitative measures. We have implemented an in-hospital, nurse-based, continuously available, percutaneous, venoarterial cardiopulmonary bypass system, also known as extracorporeal life support (ECLS), as an adjunct to resuscitation when initial measures are ineffective.In 1986, a system for the rapid initiation of ECLS, was created in which trained critical care nurses primed an ECLS circuit and in-house physicians percutaneously placed required cannulas. From a prospective registry, we assessed long-term survival (LTS) (≥30 days, cardiopulmonary support weaned), short-term survival (<30 days, CPS weaned), or death on CPS.One hundred fifty patients (age, 57 ± 17 years) were urgently started on CPS for cardiac arrest (n = 127; witnessed, n = 124; unwitnessed, n = 3) and refractory shock (n = 23). Sixty-nine patients were weaned from CPS, and 81 could not be weaned. Overall, 39 (26.0%) patients achieved LTS with a subsequent Kaplan–Meier median survival of 9.5 years. Duration of CPS was 32 ± 38 hours for LTS and 21 ± 38 hours for non-LTS. LTS occurred in 29 (23.4%) of 124 patients started on CPS for witnessed cardiac arrest and 11 (47.8%) of 23 for refractory shock ( < .05). Among patients with CPS initiated in the cardiac catheterization laboratory, LTS was seen in 24 (50.0%) of 48 versus 15 (14.7%) of 102 in patients with CPS initiated in other locations ( < .001). Cardiopulmonary resuscitation times greater than or equal to 30 minutes were associated with lower LTS ( < .05). The most common cause of death during CPS was refractory cardiac dysfunction (39.5%), and the most common cause associated with short-term survival was neurologic/pulmonary dysfunction (53.6%). Seven patients were bridged to a left ventricular assist device, and 1 subsequently underwent heart transplantation. Multivariate analysis revealed only cardiac catheterization laboratory site of initiation as a significant independent predictor of LTS ( < .01). When dividing the 20-year experience in tertiles, recent recipients have had more common prearrest insertion. Rates of long-term survival have not changed.Of patients started on CPS, 46% were weaned, and 26.0% were long-time survivors. Rapid initiation of CPS permits LTS for some inpatients with cardiovascular collapse when initial advanced resuscitation fails. Strategies to improve end-organ function associated with use of CPS should lead to greater LTS. This practical application of inexpensive available technology should be more widely used

Notas sobre moscas necrófagas (Diptera: Caliptratae) associadas a carcaças de peixe na Amazônia Colombiana

In recent years, there has been an increasing number of studies on carrion fly communities due to their medical importance and as a consequence of the large number of studies on forensic entomology. Surprisingly few studies have adressed with the asynantropic flies of the Amazon, and none were done in Colombia. A faunistic study of asynantropic flies of the families Calliphoridae, Sarcophagidae, Muscidae and Fannidae in three different landscapes of the Colombian Amazon is presented, trapping effectiveness is assessed, and the first record of Mesembrinella batesi (Aldrich, 1922) and Fannia femoralis (Stein, 1897) from Colombia is reported.Apesar de existir uma quantidade considerável de estudos sobre dípteros decompositores devido a sua importância medica e ao avanço da entomologia forense, poucos dizem respeito as moscas asinantrópicas na Amazônia e nada foi feito na Colômbia. No presente trabalho é feito um estudo faunístico sobre moscas, principalmente das famílias Calliphoridae, Sarcophagidae, Muscidae e Fanniidae em três diferentes paisagens da Amazônia Colombiana, além do primeiro registro das espécies Mesembrinella batesi (Aldrich, 1922) e Fannia femoralis (Stein, 1897) para Colômbia e avaliação da amostragem utilizada

Keeping Fish Wet in Montana: Private Water Leasing: Working Within the Prior Appropriation System to Restore Streamflows

Innovative and collaborative approaches are making headway in addressing dwindling water resources in the American west. Watershed organizations that emphasize the virtue of cooperative conservation to preserve and protect a resource we value for its ecological and cultural importance are springing up across the region. Throughout the western states, irrigators, farmers, ranchers, local governments, recreationists, and conservationists are forming coalitions to address water management concerns. The necessity of preserving our water resource is decreasingly viewed as only a green mission. Water users are coming to realize that we all have a stake in water conservation. Through our cooperative conservation successes, we have demonstrated that a top-down regulatory approach to water management may not always lead to the most beneficial or fair results. The win-lose nature of the top-down approach can be avoided to ensure wiser and more effective results

Duas novas espécies de Fannia Robineau-Desvoidy (Diptera, Fanniidae) do Rio de Janeiro, Brasil Two new species of Fannia Robineau-Desvoidy (Diptera, Fannidae) from Rio de Janeiro, Brazil

<abstract language="eng">Fannia parafemoralis, sp.n. and F. paraisensis, sp.n. from Rio de Janeiro, are described. Both species belong to the cannicularis group