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Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: Objectif: Décrire l’utilisation de facteur VII activé recombinant (rFVIIa) chez des patients sous ECMO centrale veino-artérielle avec une attention particulière sur les complications thrombotiques associées. Conception de l’étude: Étude rétrospective monocentrique. Patients et méthodes: Nous avons étudié les dossiers des 91 patients mis sous ECMO entre 2005 et 2010. Durant cette période, huit patients ont présenté une hémorragie réfractaire et ont reçu du rFVIIa comme thérapeutique de sauvetage. Résultats: Chez six patients, l’hémorragie a été jugulée. Une diminution du saignement a été mise en évidence après l’administration de rFVIIa (pré-rFVIIa : 40,1±33,1mL/kg par trois heures versus 5,4±3,2mL/kg par trois heures (p =0,01). Les besoins transfusionnels ont été diminués après administration de rFVIIa. Aucun évènement thrombotique n’a été détecté. Le fibrinogène, les d-dimères, la numération des plaquettes et les lactates n’ont pas été modifiés par le traitement. Deux patients ont été sevrés de l’ECMO. Un est décédé 17jours après le sevrage. L’autre patient a survécu sans séquelles neurologiques. Conclusion: Le rFVIIa est un traitement d’exception chez le patient traité avec une ECMO centrale veino-artérielle. Il ne doit pas être administré avant que toutes les thérapeutiques conventionnelles n’aient été tentées, mais peut être une solution de sauvetage en présence d’une hémorragie massive. [ABSTRACT FROM AUTHOR]

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: Objective: Severely impaired patients may wait in France on a special and temporary high emergency national list (called SU). Some of these patients need mechanical circulatory support with ECMO. In order to compare two groups of patients on SU, who acceeded to heart transplantation (HT) with or without ECMO, we reviewed retrospectively 20 consecutive patients transplanted on SU between January2004 and September2007 in Rennes. Patients and methods: Among them, 10 were transplanted without ECMO and 10 others were implanted with a femoro-femoral ECMO before HT. Results: (1) Considering the group SU without pretransplantation ECMO: 2years survival rate was 70%. Mean hospital stay was 26.4 days. Three patients were implanted with ECMO for graft dysfunction during postoperative course, without inherent complication. None graft dysfunction occurred after initial hospitalization; (2) considering the group SU with pretransplantation ECMO: 2years survival rate was 90% (one early death). Mean hospital stay was 45 days with multiple complications due to the ECMO (leg''s ischemia: n =2; lung oedema: n =1; lymphorrhea: n =3, low flow requiring change of canulae: n =1). None graft dysfunction occurred after initial hospitalization. Conclusion: Althought we didn’t reach statistical significance, it seems that ECMO for patients in SU may be useful as bridge to transplant but with a higher morbidity than for similar patients transplanted without ECMO. Additional data from other transplant centers are needed to confirm our findings. [Copyright &y& Elsevier]

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Cardiogenic shock is the leading cause of in-hospital death for myocardial infarction. Despite therapeutic improvements, such as medical treatment with inotropes, myocardial revascularization, circulatory assistance can be an option. Intra-aortic balloon pumping is highly recommended in the presence of haemodynamic impairment. If the patient continues to deteriorate and cardiac function cannot maintain adequate circulation to prevent end-organ failure, several mechanical circulatory assist devices can be considered: extracorporeal membrane oxygenator (ECMO), Impella®… These devices should be used at tertiary centres either as bridge to recovery or as bridge to transplantation or as bridge to long-term left ventricle assist device. [ABSTRACT FROM AUTHOR]

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]

Résumé: Le syndrome de tako-tsubo est une cardiomyopathie rare, secondaire à la toxicité de hauts niveaux de catécholamines circulantes responsables d’une sidération myocardique. De sévères complications peuvent survenir telles qu’un choc cardiogénique ou une fibrillation ventriculaire. Nous présentons ici le cas d’une patiente de 32ans victime d’un syndrome de tako-tsubo avec choc cardiogénique sévère au cours d’une césarienne en urgence pour souffrance fœtale. Cette patiente a bénéficié d’une assistance circulatoire par Extracorporeal Membrane Oxygenation (ECMO) devant le caractère réfractaire de l’état de choc. [ABSTRACT FROM AUTHOR]

Résumé: Les traumatismes crâniens graves sont particulièrement sensibles à l’hypoxémie. Les moyens de recouvrir une oxygénation adéquate chez les patients associant des lésions crâne-poumon sont peu décrits. Nous rapportons le cas d’un recours à l’ECMO chez une jeune patiente neurolésée, en hypoxémie réfractaire dans les suites d’un polytraumatisme. [ABSTRACT FROM AUTHOR]

Abstract: The concept of reproduction without uterus, or ectogenesis, has long been considered a myth. Nowadays, however, the in vitro conception (IVF) and embryo culture before implantation are largely used in humans with more than 50,000 IVF and ICSI procedures yearly in France, but also in ruminants where about 400,000 bovine embryos are produced in vitro worldwide each year. In order to proceed with gestation, a 3D structure enabling implantation is needed. Ex-vivo implantation of human embryos was obtained both in a perfused ex-vivo uterus and in a 3 dimensional culture of endometrial cells, but these experiments were stopped because of ethical concerns. The implantation of a mouse embryo in a similar 3D structure has been reported but did not lead to the production of a live pup. Another interest for an artificial uterus or placenta would be to use it for ex-vivo maturation of very premature fetuses. Extra-corporal membrane oxygenation (ECMO) was developed for many years but its use remains disappointing in preterm infants when compared to the important progress made with more classical clinical care. In any case, goat fetuses have been maintained alive up to 9 days in an artificial amniotic pouch, being oxygenated via ECMO. [Copyright &y& Elsevier]

Abstract: Respiratory support using extra corporeal membrane oxygenation (ECMO) is rarely used in the setting of adult lung surgery, with the exception of lung transplantation. We report the case of a patient with pulmonary aspergilloma, for whom selective bronchial intubation was required to facilitate surgery. Intolerance to unilateral ventilation was anticipated due to poor underlying lung function. Intra-operatively, an attempt to lung exclusion was responsible for severe hypoxemia. The use of veno-venous ECMO allowed to improve oxygenation and lung resection was carried out successfully at the expense of major intra-operative bleeding. [Copyright &y& Elsevier]

Abstract: Since the 1970s, it has become possible to handle patients with serious pulmonary and cardiac failure with extracorporeal membrane oxygenation (ECMO) when conventional treatment fails, but only in specialized centers. When the latter were too far away, the risks of such transport were considered too high until the Mobile Cardiac Assistance Unit (MCAU) and Mobile Respiratory Assistance Unit (MRAU) were created. We are first going to expose the point of view of the pre-hospital Emergency Medical Services (EMS). The M.D. in need of such assistance should call the cardiac surgeon of the reference center : if the indication is confirmed, they will call the EMS (Service d’Aide Médicale Urgente, SAMU), and decide together which means is the most appropriate for a quick transportation of the team and the ECMO to the patient''s bedside, and then back to the ECMO center, depending on the problems raised by ground vehicles on the one hand and aircrafts or helicopters on the other. Then, we are going to evaluate the cost of such transportation, which is quite considerable. As a conclusion, because of its high cost, the mobile inter-hospital ECMO. service should only be used when the patient is considered too ill to be transported on conventional therapy : in that case, this procedure represents huge progress. [Copyright &y& Elsevier]

Abstract: Mobile ECMO support for remote cardiac or respiratory assistance (MESRCA and MESRRA) allows mobilization of the medical and paramedical team 24/7 in a very large geographical area. Mobility and autonomy require adapted devices. During many years, teams had to deal with non useful equipment. Recently, thanks to interest of medical world and laboratories, many materials especially suitable for this activity are developed. We describe our local experience and solutions we tented to fi nd to deal with material diffi culties. [Copyright &y& Elsevier]

Copyright of IRBM is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IRBM is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IRBM is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)