Search

Résumé: Objectif: Le transport de patients instables aux Antilles-Guyane représente un défi particulier ; pour assurer une continuité territoriale des soins, le service de chirurgie cardiaque de Fort-de-France a créé une unité mobile d’assistance circulatoire. Le but de ce travail est de décrire les aspects logistiques, techniques et financiers des transferts interhospitaliers de patients assistés par circulation extracorporelle temporaire. Patients et méthodes: Tout patient sous assistance circulatoire temporaire aux Antilles-Guyane, rapatrié secondairement vers le CHU de Fort-de-France, a été inclus du 29 décembre 2009 au 30 septembre 2011. L’indication et le type d’assistance utilisée, le lieu de prise en charge, le vecteur de transfert, les complications inhérentes au transport, la mortalité à la sortie de l’hôpital et le coût direct de prise en charge ont été recueillis. Résultats: Dix-neuf patients ont été pris en charge par l’UMAC (sex-ratio 0,63) à distance de notre centre (âge médian 34ans [16–64]), 12 assistés par ECMO pour un SDRA réfractaire et sept par ECLS pour un choc cardiogénique réfractaire. Quatre patients ont été transférés par ambulance (7–29km), sept par hélicoptère (190–440km), huit par avion (440–1430km). Aucun décès ni évènement indésirable grave n’est à déplorer durant ces transferts. Quinze patients ont survécu à l’hospitalisation. Une étude médicoéconomique a été réalisée. Conclusion: Le transfert interhospitalier de patients assistés par ECMO/ECLS est techniquement réalisable de manière parfaitement sécurisée aux Antilles-Guyane. La coordination préalable d’une telle activité permet de l’organiser pour un coût acceptable. [ABSTRACT FROM AUTHOR]

Abstract: We reported the case of a young adult with a Lemierre syndrome, which was complicated by septic shock and ARDS. Because of rapid onset of a life-threatening hypoxemia (PaO2/FiO2 =60) in the course of the ARDS despite mechanical ventilation, ECMO was started with jugular and femoral cannulas, as rescue therapy. Good control of hypoxemia was obtained and ECMO was set up for six days. No significant complication was observed. The course was nevertheless complicated by acute renal failure and a pleural fistula that necessitated separate-lung ventilation during 24hours. After 48days left in the ICU, the patient was sent to a rehabilitation unit. [Copyright &y& Elsevier]

Abstract: Between August and September 2009, on Reunion Island, our Intensive Care Unit (ICU) treated several severe Influenza A (H1N1) S-OIV cases. We report the following case: a 23-year-old female patient with no prior medical history presented a severe respiratory distress that required high frequency oscillation ventilation and finally Extracorporeal Membrane Oxygenation (ECMO). She was hospitalized in the ICU for 41 days. Recovery was complete. It is important to note the stead of each technique in those types of respiratory distresses and describe the practical details of the ECMO''s set up by a non-trained medical crew. We want to underline, within the current context of severe respiratory distresses due to Influenza A pandemic, the necessity to develop a multidisciplinary care network, or to reinforce the existing channels between well-trained medical crews familiar with ECMO''s technics and the ICU that are not. [Copyright &y& Elsevier]

Abstract: Pertussis is a leading cause of death from community infections in infant. Life-threatening clinical presentations of pertussis can associate multiple organ system failure with respiratory distress. The question of the optimal management of these severe forms of pertussis, in order to reduce the high mortality rate, is raised by the clinicians caring for such patients. We report the case of a 1month infant who was admitted to the pediatric intensive care unit (PICU) for a severe pertussis. He presented with an acute respiratory distress syndrome, a severe pulmonary hypertension was treated initially with mechanical ventilation and nitric oxide. At day 4 (D4), a cardiogenic shock occurred and, despite epinephrine and norepinephrine infusion, fluid expansion, the hemodynamic condition worsened with two episodes of cardiac arrest. The child was then successfully resuscitated, and, facing the extreme hemodynamic instability, extracorporeal membrane oxygenation (ECMO) was considered. ECMO allowed epinephrine and norepinephrine to be progressively discontinued, and protective mechanical ventilation. ECMO withdrawal was possible at D9, with milrinone as the sole inotropic agent. Weaning from mechanical ventilation was possible on D15 and the total length of stay in PICU was 20days. While the analysis of the literature, through limited experiences on the use of ECMO in children with severe pertussis does not allow concluding definitively on the utility of ECMO in this situation, the contribution of ECMO in the favourable outcome for our patient was considerable. This is an argument, to our opinion, for considering ECMO in the management of those very instable patients. [Copyright &y& Elsevier]