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Introduction: Mechanical circulatory support is becoming a more common therapy for end-stage heart failure in intensive cardiac care unit, and currently there are several types of devices that can be used as bridge therapy to recovery phase or hearth transplantation. Extracorporeal membrane oxygenation (ECMO) replaces heart and lung function using extracorporeal blood flow and it can be used as mechanical support in cardio-circulatory or respiratory failure.1 In a patient on ECMO support there is a strong activation of inflammatory response in a short period of time, usually due to shock before the initiation of support, but also, due to long, non-physiological blood flow through the piping, rotational pump and the oxygenator, where there is higher possibility of development of infection. In this phase patients are hemodynamically unstable, dependent on vasoactive support and substitution of intravenous fluids with a raise in inflammatory markers seen in laboratory results. Adsorbers for extracorporeal blood purification (CytosorbTM) can absorb molecules ranging from 5 to 55 kDa, which is the size where cytokines and some metabolites such as bilirubin, bile acids and ammonium can be absorbed, and it can be used to control inflammatory response which eventually can damage blood vessel walls and lead to target organs damage. Case report: This case report will show a 38-year-old patient who was hospitalized in Department of Cardiac Intensive Care after deterioration of his primary condition (cardiomyopathy) with hemodynamic instability, which lead to placement of both left and right sided mechanical circulatory support with an adsorber. This led to a decrease of inflammatory markers with good clinical and microbiological response. Patients soon underwent heart transplantation without any major complications and fast recovery. Conclusion: Use of adsorber via ECMO machine or dialysis machine is a very complex procedure which needs responsible approach to intervention and the only guarantee of success lays in a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Introduction: Heart failure is a chronic, progressive condition in which a heart muscle cannot pump enough blood through the heart to meet the blood and oxygen requirements of the body.1 It is the result of numerous primary and secondary diseases that lead to impaired heart pump function and reduced heart rate. Recognizing symptoms and establishing diagnosis is an extremely important part of the treatment and therapy of such patients. Through all forms of treatment of such patients, clinically, medically and ultimately surgically, physiotherapeutic processes are present as important factors in the medical team. Methods of monitoring, evaluation and physiotherapeutic intervention itself are performed and recorded in a standardized physiotherapeutic card and qualified questionnaires. The left ventricle assists device (LVAD) is mechanical support that is surgically embedded. It helps maintain the ability of a heart pump that cannot function independently. The LVAD device, sometimes referred to as the "bridge for transplantation", is now used in longterm therapy. People often have to wait a long time before the appropriate heart becomes available. During this waiting, the already weakened heart of the patient may become even worse. Case report: A case study of a patient with diagnosis of dilated cardiomyopathy, received through Emergency services, continuation of treatment in the Coronary Unit, Intensive Care Unit and ultimately at the Institute for Cardiac and Transplant Surgery. Because of the underlying disease, the patient was connected to the extracorporeal membrane oxygenation device, and LVAD was later embedded into the operation. Outstandingly bad respiratory and condition status, physiotherapeutic intervention started in the intensive care unit and continued in the department. After a series of complications, the patient with that has undergone frequent early rehabilitation for 3 months has left our clinic and managed to proceed with daily life activities completely independent. She is currently on the transplant list. Conclusion: Given the difficult diagnosis, our patient has been able to overcome all the complications occurring in such a difficult state with the help of the built-in LVAD. A series of respiratory and musculoskeletal complications during surgical treatment required special expertise and knowledge of physiotherapists who, through their physiotherapeutic processes, helped the patients to re-actively engage in everyday lifestyle rhythm. [ABSTRACT FROM AUTHOR]

Extracorporeal Membrane Oxygenation (ECMO) is an extracorporeal technique of providing prolonged cardiac and respiratory support that is used in patients with lifethreatening forms of heart or lung failure. There are two basic forms of ECMO support: venous-venous (V-V) and venous-arterial (V-A) ECMO.1,2 This paper presents experience with the use of veno-arterial extracorporeal membrane oxygenation (VA ECMO). Since 2017, peripheral VA ECMO support has been applied in 16 patients (14 men and 2 women). The most common indication for application is cardiogenic shock (62.5%). The average time period spent on the VA ECMO is 64 hours. Of the reported complications, the most common is bleeding (mostly at the canulation site) which is present in 56.2% of cases. Of the total number of patients, 13 (81.3%) were successfully separated from ECMO support, and 9 (56.3%) survived untill the discharge or untill the transfer to another institution. The application of the VA ECMO in the cardiology intensive care unit has greatly improved the chances of survival of the most critical patients. [ABSTRACT FROM AUTHOR]