Unusual case of successful treatment of a ruptured thoracoabdominal aneurysm in elderly woman

We describe a case of a 76-year-old woman who underwent emergent surgery for ruptured thoracoabdominal aneurysm with the use of partial left heart bypass. Dacron prosthesis was implanted into the thoracic and abdominal aorta (up to its bifurcation), and four visceral arteries were reimplanted into the prosthesis. The procedure of implanting the prosthesis into the thoracic part of the descending aorta was supported by left heart bypass. The patient’s postoperative course was complicated by spinal cord ischaemia-induced lower extremities paraparesis. On the 26th postoperative day, she was referred to the regional neurological rehabilitation centre

Paramedic students need more training in left ventricular assist device — a pilot simulation study

INTRODUCTION: Mechanical Circulation Systems are a promising therapy for patients with end-stage of heart failure. Left ventricular assist device (LVAD) enforces using of concomitant anticoagulant therapy. This may lead to severe complications. LVAD patients are more and more frequent users of the emergency department. There are several differences in cardiovascular function in these patients, as well as on examination. Its interpretation may be challenging and result in potentially fatal conclusions. The aim of this research was to assess the skills of paramedic students in assessing patients with LVAD MATERIAL AND METHODS: The study was designed as a simulation study. The aim of this scenario was to provide a full primary survey of an unconscious, spontaneously breathing person with an LVAD pump implanted. Ten groups of paramedic students from Polish medical universities took part in this study. RESULTS: Four teams started chest compressions unnecessarily. Of them, only one had contacted LVAD local coordinator and discontinued after short instructions. Four teams completed the driveline and device check and six checked only the line without moving the controller. No major errors were noted in the field of airway assessment and management as well as assessment of consciousness, breathing, and circulation. CONCLUSIONS: More attention should be paid to educating paramedic students in LVAD therapy. Educators should focus mainly on differences in cardiovascular function and pay attention to complete perfusion assessment. Medical simulation seems to be a good tool for assessing difficult clinical cases rarely encountered in practice

Managing patients on extracorporeal membrane oxygenation support during the COVID-19 pandemic – a proposal for a nursing standard operating procedure

Background Extracorporeal membrane oxygenation (ECMO) is effective in a selected critically ill patient population with promising results in refractory hypoxemia related to the novel coronavirus disease (COVID-19). However, it requires specialized clinicians and resources in advanced technology. Moreover, the COVID-19 remains an ongoing global emergency, and there is no evidence-based practice in preparedness. This article proposes an innovative and optimized nursing care protocol, the Standard Operating Procedure (SOP), that regulates safety and efficiency in using personal protective equipment (PPE) during ECMO-relevant procedures while providing ECMO therapy for patients with COVID-19. Methods After performing a narrative literature search, we developed a high-fidelity translational simulation scenario. It included practicing appropriate donning and doffing PPE during work organization, ECMO-related procedures, and routine daily nursing care and management of ECMO over nine hours. In addition, we held supplementary constructive debrief meetings to consult international expert in the field. Results A proposal for nursing standardized operating procedures was created, divided into categories. They included work organization, workload references, competences, infrastructural conditions, cannulation equipment, daily routine nursing care, and procedures during ECMO. Conclusions High-fidelity medical simulation can play an important role in staff training, improvement in previously gained proficiency, and development of optimal SOP for nursing care and management during ECMO in patients with COVID-19. Optimal SOPs may further guide multidisciplinary teams, including intensive care units and interventional departments

Patient Safety during ECMO Transportation: Single Center Experience and Literature Review

Background. Extracorporeal membrane oxygenation (ECMO) has been proven to support in lifesaving rescue therapy. The best outcomes can be achieved in high-volume ECMO centers with dedicated emergency transport teams. Aim. The aim of this study was to analyze the safety of ECMO support during medical transfer on the basis of our experience developed on innovation cooperation and review of literature. Methods. A retrospective analysis of our experience of all ECMO-supported patients transferred from regional hospital of the referential ECMO center between 2015 and 2020 was carried out. Special attention was paid to transportation-related mortality and morbidity. Moreover, a systematic review of the Medline, Embase, Cochrane, and Google Scholar databases was performed. It included the original papers published before the end of 2019. Results. Twelve (5 women and 7 men) critically ill ECMO-supported patients with the median age of 33 years (2–63 years) were transferred to our ECMO center. In 92% (n = 11) of the cases venovenous and in 1 case, venoarterial supports were applied. The median transfer length was 45 km (5–200). There was no mortality during transfer and no serious adverse events occurred. Of note, the first ECMO-supported transfer had been proceeded by high-fidelity simulations. For our systematic review, 68 articles were found and 22 of them satisfied the search criteria. A total number of 2647 transfers were reported, mainly primary (90%) and as ground transportations (91.6%). A rate of adverse events ranged from 1% through 20% but notably only major complications were mentioned. The 4 deaths occurred during transport (mortality 0.15%). Conclusions. Our experiences and literature review showed that transportation for ECMO patients done by experienced staff was associated with low mortality rate but life-threatening adverse events might occur. Translational simulation is an excellent probing technique to improve transportation safety