Issues to resolve with the use of extracorporeal membrane oxygenation during interfacility transportation.

Extracorporeal membrane oxygenation (ECMO) support is indicated for patients who are refractory to treatment, those with cardiogenic shock or respiratory failure and those with exacerbations eligible for heart and lung transplantation. The practitioner’s experience and quantity of necessary resources are reasons why regionalization could benefit these types of patients, establishing ECMO reference centers and integrating a transportation network specialized in ECMO. This type of transportation is a challenge for healthcare systems and physicians, given its greater complexity, requiring a multidisciplinary and interterritorial approach. ECMO transportation is safer than without mechanical support, although there are currently no criteria for starting the therapy on patients being transferred. Criteria of lesser severity might be necessary for these patients. The training and specialization of the team in extracorporeal support therapies, interfacility transport and the systemization of the transfer can improve results. There are no studies on the conditions that must be met by the transportation media, although space and stability are important characteristics. Air transfer with ECMO is an increasingly frequent option. Although there are data on its safety, there are none on the physiology of patients undergoing ECMO at high altitudes, data that could help with the indication and management of this type of transportation.pre-print916 K

Surgical approach for cardiac surgery in a patient with tracheostoma

The thoracic approach for cardiac surgery in a patient with a tracheostoma can result in difficult problems, such as mediastinitis, stoma necrosis or inadequate operative exposure. We present a distinct approach consisting of an incision at the second intercostal space, transverse sternum transection and longitudinal median sternotomy to the xiphoid process, performed for coronary artery bypass grafting and aortic valve replacement, in a patient with previous tracheotomy. This approach permitted adequate surgical exposure for cardiopulmonary bypass, aortic valve replacement and coronary revascularization procedures

TP86 154. ¿Es útil el sistema de asistencia oxigenador de membrana extracorpórea en el tromboembolismo pulmonar masivo?

IntroducciónEn España, en series de autopsias se ha descubierto que la causa de muerte es un tromboembolismo pulmonar (TEP) en un 2,6%. La aparición de esta enfermedad está claramente aumentada en los pacientes oncológicos. En ocasiones las medidas clásicas del tratamiento del TEP no surgen efecto y el paciente puede fallecer; en estos casos está indicada la implantación de una asistencia cardiorrespiratoria.Material y métodosPaciente de 35 años con quimioterapia por un seminoma. Ingresa por disnea y dolor torácico con mala evolución. Se traslada a unidad de coronarias donde se diagnostica de un TEP bilateral masivo y disfunción importante ventricular derecha presentando dos episodios de parada cardiorrespiratoria. Tras las maniobras de resucitación se implanta oxigenador de membrana extracorpórea (ECMO) venoarterial que se mantiene 5 días, mientras tanto se hepariniza al paciente completamente.ResultadosEl paciente es extubado y dado de alta a los 21 días. Tras un seguimiento de 20 meses el paciente permanece vivo.ConclusiónEl sistema ECMO venoarterial es muy útil en pacientes con TEP, ya que realiza dos funciones: descargar el corazón derecho y oxigenar al paciente. Podemos heparinizar al paciente para revertir el cuadro, ya que las incisiones a nivel femoral son fácilmente controladas

TP87 153. Implantación de dos sistemas de oxigenador de membrana extracorpórea a un paciente en dos ingresos: Uno como recuperación, otro como puente a otra asistencia

IntroducciónLos programas de asistencias mecánicas de corta duración se empiezan a desarrollar en nuestro país. Uno de los más utilizados es el oxigenador de membrana extracor-pórea (ECMO), cuya mayor indicación en nuestro entorno es como puente al trasplante. Presentamos un caso en el que se coloca como recuperación, y tras 3 meses otra nueva como puente a otra asistencia.Material y métodosPaciente de 61 años que ingresa por trombosis de stent en descendente anterior (DA), presentando shock cardiogénico refractario a fármacos y balón de contrapulsación. Dada la situación se coloca ECMO venoarterial que se retira a las 72h por mejoría, dándose de alta el paciente a los 19 días.Tres meses después el paciente ingresa con bajo gasto y edema de pulmón, implantándose un ECMO venoarterial en el box de intensivos como puente a asistencia univentricular Levitronix, que se coloca 10h después en quirófano. Se reinterviene dos veces por taponamiento y se extuba a los 7 días, momento en que se incluye en alarma 0. Tras 27 días con Levitronix izquierda, la paciente sufre un ictus y retiramos de lista, falleciendo la paciente.ResultadosLos dos ECMO cumplieron su objetivo: uno de recuperación y el otro de puente a la asistencia.ConclusionesComo describimos en este caso, el ECMO es muy útil y fácil de implantar en pacientes con el objetivo de la recuperación o como puente al trasplante. Las asistencias no están exentas de complicaciones

A rare benign disorder mimicking metastasis on radiographic examination: a case report of osteopoikilosis

Osteopoikilosis (OPK) is a rare, autosomal dominant bone disorder, characterized by multiple, discrete round or ovoid radio densities scattered throughout the axial and appendicular skeleton. OPK is usually asymptomatic but rarely there may be slight articular pain and joint effusions. OPK is generally diagnosed incidentally on radiographic examinations and may mimic different bone pathologies, including bone metastases. Radionuclide bone scan has a critical role in distinguishing OPK from osteoblastic bone metastases. In this case report, we present a young man with right hip pain due to OPK, whose plain radiogram and computerized tomography findings thought cancer metastasis

Factors related to the development of health-promoting community activities in Spanish primary healthcare: two case-control studies.

Objective Spanish primary healthcare teams have the responsibility of performing health-promoting community activities (CAs), although such activities are not widespread. Our aim was to identify the factors related to participation in those activities. Design Two case–control studies. setting Performed in primary care of ve Spanish regions. subjects In the rst study, cases were teams that performed health-promoting CAs and controls were those that did not. In the second study (on case teams from the rst study), cases were professionals who developed these activities and controls were those who did not. Main outcome measures Team, professional and community characteristics collected through questionnaires (team managers/professionals) and from secondary sources. results The rst study examined 203 teams (103 cases, 100 controls). Adjusted factors associated with performing CAs were percentage of nurses (OR 1.07, 95% CI 1.01 to 1.14), community socioeconomic status (higher vs lower OR 2.16, 95% CI 1.18 to 3.95) and performing undergraduate training (OR 0.44, 95% CI 0.21 to 0.93). In the second study, 597 professionals responded (254 cases, 343 controls). Adjusted factors were professional classi cation (physicians do fewer activities than nurses and social workers do more), training in CAs (OR 1.9, 95% CI 1.2 to 3.1), team support (OR 2.9, 95% CI 1.5 to 5.7), seniority (OR 1.06, 95% CI 1.03 to 1.09), nursing tutor (OR 2.0, 95% CI 1.1 to 3.5), motivation (OR 3.7, 95% CI 1.8 to 7.5), collaboration with non-governmental organisations (OR 1.9, 95% CI 1.2 to 3.1) and participation in neighbourhood activities (OR 3.1, 95% CI 1.9 to 5.1). Conclusions Professional personal characteristics, such as social sensitivity, profession, to feel team support or motivation, have in uence in performing health-promoting CAs. In contrast to the opinion expressed by many professionals, workload is not related to performance of health-promoting CAs

Role of age and comorbidities in mortality of patients with infective endocarditis

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015. Patients were stratified into three age groups:<65 years, 65 to 80 years, and = 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. Results: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 = 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients =80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, =80 years). In-hospital mortality was lower in the <65-year group (20.3%, <65 years;30.1%, 65-79 years;34.7%, =80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%, =80 years; p = 0.003).Independent predictors of mortality were age = 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI = 3 (HR:1.62; 95% CI:1.39–1.88), and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. Age = 80 years, high comorbidity (measured by CCI), and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Caracterización del Banco de La Concepción

Se integra información hidrográfica, geomorfológica, sedimentológica, biológica, sobre hábitats marinos y pesquera, para establecer las bases ecológicas necesarias para la protección y conservación del Banco de La ConcepciónEl proyecto INDEMARES ha permitido utilizar amplios medios económicos y personales para estudiar en detalle y desde múltiples perspectivas la zona del Banco de La Concepción. Se han aplicado metodologías para el estudio de la hidrografía, caracterizando la región, describiendo sus principales masas de agua y la hidrodinámica de las corrientes. También se ha abordado la geología de la zona, incluyendo levantamientos batimétricos, perfiles sísmicos, muestreos de sedimento y petrológicos, obteniendo modelos digitales del terreno, mapas de tipos de fondo, geomorfológicos. Se han caracterizado las comunidades bentopelágicas, demersales, epibentónicas y endobentónicas, prestando especial atención a aquellas que conforman o estructuran los hábitats sensibles cuyo inventariado y cartografía era objeto principal del proyecto. Los trabajos de identificación de hábitats se han realizado con muestreadores directos, pero también con muestreadores visuales, que han permitido hacer un mayor esfuerzo de muestreo sin aumentar el impacto sobre los fondos de la zona. Por otro lado se ha estudiado la huella pesquera de la zona por medio del análisis de los datos VMS y los cuadernos de pesca proporcionados por la SGP, además de una ardua labor a pie de puerto de entrevistas y encuestas. Toda la información ha sido gestionada y analizada por diferentes grupos de investigación de diferentes centros (Universidad de La Laguna, Instituto Universitario de Ciencias Políticas y Sociales, Universidad de Las Palmas de Gran Canaria, Instituto de Ciencias del Mar de Barcelona, Universidad de Barcelona, Centro de Investigaciones Medioambientales del Atlántico, Centro Oceanográfico de Santander y Centro Oceanográfico de Málaga del Instituto Español de Oceanografía, …), aunque el grueso de esta labor, además de la coordinación, se ha llevado a cabo en el Centro Oceanográfico de Canarias del Instituto Español de Oceanografía. Los resultados permiten tener un conocimiento profundo y multidisciplinar de la zona de estudio comparable a pocos proyectos de investigación marina en la macaronesia. El estudio oceanográfico, el geológico, y el de las comunidades biológicas, ha permitido la caracterización de los hábitats de la zona, y su cartografiado mediante el intenso muestreo y la aplicación de análisis de idoneidad de hábitats.INDEMARES Project made possible to bring together economic and staff resources to study in detail, and from multiple perspectives, the area of Banco de La Concepción. Methodologies have been applied to study hydrography, making a regional characterization, depicting main water masses, and current hydrodynamics. Geology has been tackled including bathymetric uplifting, seismic profiles, sediment and petrological sampling, obtaining digital terrain models, type of bottom maps, geomorphological maps, as an output. Benthopelagic, demersal, epibenthic and endobenthic communities have been characterized, paying special attention to sensitive habitats which inventory and mapping was the project’s main aim. Habitat identification has been made with direct and visual samplers, the latter making a major sampling effort possible without an increase of bottom impact. Moreover, fisheries footprint has been identified by Vessel Monitoring System data, together with logbooks from Secretaría General de Pesca (Fisheries Ministry), as well as a hard interviewing and surveying task at landing points. Information has been managed and analysed by different research groups from different Centres (Universidad de La Laguna, Instituto Universitario de Ciencias Políticas y Sociales, Universidad de Las Palmas de Gran Canaria, Instituto de Ciencias del Mar de Barcelona, Universidad de Barcelona, Centro de Investigaciones Medioambientales del Atlántico, Centro Oceanográfico de Santander y Centro Oceanográfico de Málaga del Instituto Español de Oceanografía), although the main body of the work, plus coordination, has been made by the Canary Islands Oceanographic Centre, from the Spanish Institute of Oceanography. Results let us have a multidisciplinary profound knowledge of the study zone, comparable to few other marine research projects off Macaronesia. The study about oceanography, geology and biologic communities has allowed the habitats characterization and mapping by means of intensive sampling and habitat suitability analysis.Instituto Español de Oceanografía, Comisión Europea Programa LIFE+, Fundación Biodiversida

Caracterización del Sur de Fuerteventura

Se integra información hidrográfica, geomorfológica, sedimentológica, biológica, sobre hábitats marinos y pesquera, para establecer las bases ecológicas necesarias para la protección y conservación del Sur de Fuerteventura (Montes de Amanay y El Banquete)El proyecto INDEMARES ha permitido utilizar amplios medios económicos y personales para estudiar en detalle y desde múltiples perspectivas la zona del Sur de Fuerteventura (montes de Amanay y El Banquete). Se han aplicado metodologías para el estudio de la hidrografía, caracterizando la región, describiendo sus principales masas de agua y la hidrodinámica de las corrientes. También se ha abordado la geología de la zona, incluyendo levantamientos batimétricos, perfiles sísmicos, muestreos de sedimento y petrológicos, obteniendo modelos digitales del terreno, mapas de tipos de fondo, geomorfológicos. Se han caracterizado las comunidades bentopelágicas, demersales, epibentónicas y endobentónicas, prestando especial atención a aquellas que conforman o estructuran los hábitats sensibles cuyo inventariado y cartografía era objeto principal del proyecto. Los trabajos de identificación de hábitats se han realizado con muestreadores directos, pero también con muestreadores visuales, que han permitido hacer un mayor esfuerzo de muestreo sin aumentar el impacto sobre los fondos de la zona. Por otro lado se ha estudiado la huella pesquera de la zona por medio del análisis de los datos VMS y los cuadernos de pesca proporcionados por la SGP, además de una ardua labor a pie de puerto de entrevistas y encuestas. Toda la información ha sido gestionada y analizada por diferentes grupos de investigación de diferentes centros (Universidad de La Laguna, Instituto Universitario de Ciencias Políticas y Sociales, Universidad de Las Palmas de Gran Canaria, Instituto de Ciencias del Mar de Barcelona, Universidad de Barcelona, Centro de Investigaciones Medioambientales del Atlántico, Centro Oceanográfico de Santander y Centro Oceanográfico de Málaga del Instituto Español de Oceanografía, …), aunque el grueso de esta labor, además de la coordinación, se ha llevado a cabo en el Centro Oceanográfico de Canarias del Instituto Español de Oceanografía. Los resultados permiten tener un conocimiento profundo y multidisciplinar de la zona de estudio comparable a pocos proyectos de investigación marina en la Macaronesia. El estudio oceanográfico, el geológico, y el de las comunidades biológicas, ha permitido la caracterización de los hábitats de la zona, y su cartografiado mediante el intenso muestreo y la aplicación de análisis de idoneidad de hábitats.Abstract: INDEMARES Project made possible to bring together economic and staff resources to study in detail, and from multiple perspectives, the area of South of Fuerteventura (Amanay and El Banquete Semounts). Methodologies have been applied to study hydrography, making a regional characterization, depicting main water masses, and current hydrodynamics. Geology has been tackled including bathymetric uplifting, seismic profiles, sediment and petrological sampling, obtaining digital terrain models, type of bottom maps, geomorphological maps, as an output. Benthopelagic, demersal, epibenthic and endobenthic communities have been characterized, paying special attention to sensitive habitats which inventory and mapping was the project’s main aim. Habitat identification has been made with direct and visual samplers, the latter making a major sampling effort possible without an increase of bottom impact. Moreover, fisheries footprint has been identified by Vessel Monitoring System data, together with logbooks from Secretaría General de Pesca (Fisheries Ministry), as well as a hard interviewing and surveying task at landing points. Information has been managed and analysed by different research groups from different Centres (Universidad de La Laguna, Instituto Universitario de Ciencias Políticas y Sociales, Universidad de Las Palmas de Gran Canaria, Instituto de Ciencias del Mar de Barcelona, Universidad de Barcelona, Centro de Investigaciones Medioambientales del Atlántico, Centro Oceanográfico de Santander y Centro Oceanográfico de Málaga del Instituto Español de Oceanografía), although the main body of the work, plus coordination, has been made by the Canary Islands Oceanographic Centre, from the Spanish Institute of Oceanography. Results let us have a multidisciplinary profound knowledge of the study zone, comparable to few other marine research projects off Macaronesia. The study about oceanography, geology and biologic communities has allowed the habitats characterization and mapping by means of intensive sampling and habitat suitability analysis.Instituto Español de Oceanografía, Comisión Europea Programa LIFE+, Fundación Biodiversida