Преобразование кардиологических палат интенсивной терапии в кардиологическую реанимацию. Пятилетняя эволюция

The article highlights the key elements and results of the restructuring of emergency care for patients with acute myocardial infarction, the core of which is the teamwork of surgeons, anesthesiologist-intensivists and cardiologists of the department. The restructuring included a change in ideology, personnel changes, updating and expanding the range of equipment, development of inner protocols and their implementation. It took two years to transform the intensive care unit for patients with acute myocardial infarction into the cardiac intensive care unit, where patients with acute cardiac pathologies of various etiologies are treated and preoperative preparation and postoperative nursing are carried out.В статье освещаются ключевые элементы и результаты реструктуризации неотложной помощи пациентам с острым инфрактом миокарда, ядром которой является командная работа хирургов, анестезиологов-реаниматологов и кардиологов в отделении. Реструктуризация включала в себя изменение идеологии, кадровые перестановки, обновление и увеличение номенклатуры оборудования. Трансформация отделения интенсивной терапии для пациентов с острым инфарктом миокарда в отделение кардиореанимации, где проходят лечение пациенты с острой кардиальной патологией разной этиологии и проводится предоперационная подготовка и послеоперационное выхаживание, заняла два года

СЛУЧАЙ УСПЕШНОГО ПРИМЕНЕНИЯ ЭСТРАКОРПОРАЛЬНОЙ МЕМБРАННОЙ ОКСИГЕНАЦИИ ПРИ КРИТИЧЕСКОМ МИТРАЛЬНОМ СТЕНОЗЕ С ТРОМБОЗОМ ЛЕВОГО ПРЕДСЕРДИЯ

Extracorporeal membrane oxygenation is considered either as a linking procedure restoring functioning of an organ or as a link to organ grafting. If there is no expectancy to bring back pulmonary or cardiac functioning and grafting is out of feasibility, one should consider ECMO to be meaningless. In this paper we have demonstrated a successful application of ECMO in a 55 y. o. female patient with terminal stage of critical mitral valve stenosis with left atrial thrombus and her left ventricular ejection fraction (LVEF) was 16%. Following 4-day perfusion due to a noticeable positive dynamics the patient underwent mitral valve replacement and LA thrombus removal. In fi ve days after the surgery ECMO was disconnected. At discharge LV ejection fraction was 43%.Conclusions: we believe ECMO should be more widely applied in cardiac surgery.Процедура ЭКМО рассматривается либо как «мост» к восстановлению функции органа, либо как «мост» к трансплантации органа. Если же надежды на восстановление функции сердца или легких нет, а возможность их трансплантации отсутствует, то рассматривать подключение ЭКМО бессмысленно. В данном сообщении мы приводим случай успешного применения ЭКМО у пациентки 55 лет в терминальной стадии критического митрального стеноза с тромбозом левого предсердия и фракцией выброса левого желудочка (ФВ ЛЖ) 16%. После 4 дней перфузии на фоне выраженной положительной динамики пациентке было успешно выполнено протезирование митрального клапана и тромбэктомия из левого предсердия. Через 5 суток после операции отключена ЭКМО. На момент выписки из стационара ФВ ЛЖ составляла 43%.Выводы: ЭКМО может более широко применяться в кардиохирургической практике

FATAL VASCULAR COMPLICATION AT PERIPHERIC VA ECMO. IT IS POSSIBLE TO AVOID OR NOT?

This article describes the possible and fatal vascular complication after cannulation for peripheral ECPR (venoarterial ECMO). A patient with cardiac arrest was deemed to be placed to ECMO via cannulation of femoral artery and vein. During ongoing chest compressions femoral artery was cannulated and it was complicated by hemorrhagic shock. The consequent autopsy revealed a lengthwise arterials wall tear and abnormal position of artery and vein between each other. We believe that obtaining information about vascular bed (vessels dimension, location artery and vein and its branches) via any available imaging tool, ultrasound navigation, checking the proper position each line inside each vessel could help to avoid such tragic event

TRANSPORTATION OF THE PATIENT WITH REFRACTORY CARDIOGENIC SHOCK IN THE SETTING OF VENO-ARTERIAL EXTRACORPORAL MEMBRANE OXYGENATION

In the present article we describe a clinical case with onsite placing of veno-arterial extracorporeal membranous oxygenation in a patient with the acute myocardial infarction complicated by refractory cardiogenic shock. It allowed to stabilize his status and transport in a specialized medical institution to carry out a coronary angiography and myocardial revascularization to arrest cardiogenic shock and to achieve restoration of myocardial function and switch off ECMO. The course of disease was complicated by combined stroke with cerebral failure development and fatal outcome

THE CASE OF SUCCESSFUL APPLICATION OF EXTRACORPOREAL MEMBRANE OXYGENATION IN CRITICAL MITRAL STENOSIS WITH THROMBOSIS OF THE LEFT ATRIUM

Extracorporeal membrane oxygenation is considered either as a linking procedure restoring functioning of an organ or as a link to organ grafting. If there is no expectancy to bring back pulmonary or cardiac functioning and grafting is out of feasibility, one should consider ECMO to be meaningless. In this paper we have demonstrated a successful application of ECMO in a 55 y. o. female patient with terminal stage of critical mitral valve stenosis with left atrial thrombus and her left ventricular ejection fraction (LVEF) was 16%. Following 4-day perfusion due to a noticeable positive dynamics the patient underwent mitral valve replacement and LA thrombus removal. In fi ve days after the surgery ECMO was disconnected. At discharge LV ejection fraction was 43%.Conclusions: we believe ECMO should be more widely applied in cardiac surgery

HEART TRANSPLANTATION FOR FULMINANT MYOCARDITIS AFTER PROLONGED ECMO

During the last decade an increasing number of reported cases with ECMO application, was described as a «bridge» to heart transplantation (HTx). Herein we present a case with successful long-term EСMO application with further HTx in a 24 y.o patient. Three years after the atrial septal defect plasty the patient developed acute myocarditis, and was connected to ECMO. The total duration of еру observation was 24 days. After switching off – the ejection fraction was less than 20%, the 6-minute walking test was less than 150 meters, left ventricular end-diastolic dimension was 65 mm. In 28 days we successfully performed HTx according to bicaval method. The patient was discharged on the 30th day after HTx. His total hospital stay was 114 days. Conclusion: ECMO as a «bridge» to HTx can be successfully applied as a short-term circulatory support

«CLASS OF EVIDENCE IIB» FOR ACUTE HEART FAILURE: WHEN, WHO, WHY?

Despite a high level of standartization of principal approaches for acute coronary syndrome treatment, in acute cardiac care department there often occur cases when therapy is not to be included in present recommendations as they are non-effective and impossible for application. Myocardial infarction is one of those situations especially when it is complicated by cardiogenic shock and ventricular arrhythmia. For overwhelming majority of ‘standard’ situations we apply recommendations with a high level of evidence I or IIa. Below we present a clinical case of treatment for acute coronary syndrome with ST-segment elevation, when non-routine used recommendations with class of evidence IIb were of great importance