Severe Circulatory Failure Research Articles

Expert consensus on prevention and treatment of lower limb ischemia during transfemoral veno-arterial extracorporeal membrane oxygenation therapy in adults in China (2023)

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an important technique for the treatment of patients with severe circulatory failure, and is used in a wider range. Canulation through the femoral artery is simple and convenient, which has become the most commonly used canulation method of VA-ECMO for adults. Lower limb ischemia is a common complication in transfemoral VA-ECMO therapy, which will seriously affect the prognosis and quality of life of patients. In order to standardize the lower limb ischemia management during VA-ECMO treatment and reduce disability and mortality, Extracorporeal Life Support Professional Committee of Chinese Medical Doctor Association and Extracorporeal Life Support Professional Committee of Shandong Physician Association organized multidisciplinary medical experts with ECMO proficiency from China to develop the Expert consensus on prevention and treatment of lower limb ischemia during transfemoral veno-arterial extracorporeal membrane oxygenation therapy in adults in China (2023), based on literature review and their clinical practice experience. This consensus is expected to provide valuable reference for the prevention, monitoring and treatment of lower limb ischemia during femoral artery VA-ECMO treatment.

Cholinergic regulation of vascular endothelial function by human ChAT+ T cells

Endothelial dysfunction and impaired vasodilation are linked with adverse cardiovascular events. T lymphocytes expressing choline acetyltransferase (ChAT), the enzyme catalyzing biosynthesis of the vasorelaxant acetylcholine (ACh), regulate vasodilation and are integral to the cholinergic antiinflammatory pathway in an inflammatory reflex in mice. Here, we found that human T cell ChAT mRNA expression was induced by T cell activation involving the PI3K signaling cascade. Mechanistically, we identified that ChAT mRNA expression was induced following the attenuation of RE-1 Silencing Transcription factor REST-mediated methylation of the ChAT promoter, and that ChAT mRNA expression levels were up-regulated by GATA3 in human Tcells. In functional experiments, T cell-derived ACh increased endothelial nitric oxide-synthase activity, promoted vasorelaxation, and reduced vascular endothelial activation and promoted barrier integrity by a cholinergic mechanism. Further, we observed that survival in a cohort of patients with severe circulatory failure correlated with their relative frequency of ChAT +CD4+ Tcells in blood. These findings on ChAT+ human Tcells provide a mechanism for cholinergic immune regulation of vascular endothelial function in human inflammation.

Venoarterial-extra corporeal membrane oxygenation-assisted parathyroidectomy for hypercalcemic crisis due to parathyroid carcinoma complicated by severe circulatory and respiratory failure: a case report

BackgroundHypercalcemia crisis is a rare but severe form of hypercalcemia complicated by multiple organ failure. Hypercalcemia crisis due to hyperparathyroidism is commonly caused by a parathyroid tumor, which often requires surgical resection. However, there are no clear recommendations on when the surgery should be performed.Case presentationA 64-year-old female patient developed hyperparathyroidism due to a parathyroid tumor and hypercalcemic crisis, which was complicated by severe circulatory and respiratory failure refractory to medical therapy, and an emergent surgery was planned to resect the parathyroid tumor. To prevent intraoperative circulatory and respiratory collapse, venoarterial-extra corporeal membrane oxygenation (VA-ECMO) was introduced, resulting in a safe operation and anesthetic management.ConclusionsIn patients with hypercalcemic crisis complicated by severe circulatory and respiratory failure, induction of prophylactic VA-ECMO was useful for safe anesthetic management. Surgical resection should be performed as soon as the diagnosis is made before VA-ECMO is required.

The Role of Echocardiography in Extracorporeal Membrane Oxygenation.

Extracorporeal membrane oxygenation (ECMO) is increasingly used to temporarily support patients in severe circulatory and/or respiratory failure. Echocardiography is a core component of successful ECMO deployment. Herein, we review the role of echocardiography at different phases on extracorporeal support including candidate identification, cannulation, maintenance, complication vigilance, and decannulation. During cannulation, ultrasound is used to confirm intended vascular access and appropriate inflow cannula positioning.While on ECMO, echocardiographic evaluation of ventricular loading conditions and hemodynamics, cannula positioning, and surveillance for intracardiac or aortic thrombi is needed for complication mitigation. Echocardiography is crucial during all phases of ECMO use. Specific echocardiographic queries depend on the ECMO type, V-V, or V-A, and the specific cannula configuration strategy employed.

A case of ventricular septal rupture complicating acute myocardial infarction - A rare lethal entity posing big challenge to surgeon

Rupture of the ventricular septum, a rare but potentially fatal complication of acute myocardial infarction, is usually observed in the setting of acute myocardial infarction associated with major coronary artery occlusion. It is often accompanied by severe circulatory failure. In this paper we describe a case of a 70-year-old lady who presented with cardiogenic shock 7 days after acute myocardial infarction and was found to have ventricular septal rupture.
 Pulse volumel.11 January-December 2018-2019 p.27-32

Application of extracorporeal membrane oxygenation in newborns with refractory hypoxemia during medical evacuation

Extracorporeal membrane oxygenation is a modern therapeutic strategy aimed to stabilize vital function in a patient suffering from severe circulatory failure and refractory hypoxia.Purpose. To describe two clinical cases of venoarterial extracorporeal membrane oxygenation in neonates with mеconium aspiration syndrome, complicated by persistent pulmonary hypertension and refractory hypoxia during medical evacuation.Material and methods. The authors performed a comprehensive analysis of the condition specifics based on clinical and instrumental work up.Results. We demonstrated that early application of venoarterial extracorporeal membrane oxygenation in neonates with meconium aspiration syndrome promotes the quickest possible stabilization and reverse of hypoxia and low cardiac output.Conclusion. Venoarterial extracorporeal membrane oxygenation in neonates with meconium aspiration syndrome and refractory hypoxemia is a life-saving procedure, that can be applied during medical evacuation by qualified medical staff.

RESULTS OF FUNCTIONAL PERFORMANCE OF ABDOMINAL PRESS MUSCLES IN PATIENTS AFTER LAPAROSCOPIC CHOLECYSTECTOMY IN LONG-TERM PERIOD

The Aim is to determine the level of functional ability of abdominal muscles in patients of different ages after LCH in the long-term rehabilitation period.
 Materials and methods. Lovett's manual muscle testing (MMT) was performed on 113 patients after laparoscopic cholecystectomy (LCH), who were undergoing rehabilitation at the Morshyn kurort resort complex in 2020 and 2021. The average age of patients was 52,96±0,62 years. Patients were divided into 3 groups according to three age categories: group A - women aged 18 to 44 years (n = 14); group B - aged 45 to 59 years (n = 79); group C aged from 60 to 74 years (n = 20). Inclusion criteria: patients after LCH from 1 month to 1 year after surgery. Exclusion criteria: patients who have contraindications to testing: early postoperative period; pregnancy; severe circulatory failure, the presence of patients with neuropsychiatric pathology; peptic ulcer of the stomach and, or duodenum with bleeding, patients' refusal to participate in the study.
 Methods. Evaluators were blinded during testing. Methods of synthesis, analysis and mathematical statistics. Indicators under study: functional ability of torso flexion and rotation muscles.
 In order to assess the effect of LCH on the functional ability of the abdominal muscles, MMT was performed according to the Lovett method.
 The results of the study. The results of the assessment of the functional ability of the abdominal muscles of patients after LCH in the long term indicate a decrease in the strength of the abdominal muscles in patients of three groups. Analyzing the results, it was found that the functional ability to bend the torso was the best in the youngest group A 2.86 ± 0.20 points. Slightly lower level of torso flexion was in group B 2.44 ± 0.07 points and the worst in the oldest group C - 2.20 ± 0.11 points. A statistically significant difference was found between the three groups in this indicator. In all three groups, the level of functional flexion of the abdominal muscles of patients after LCH was low. However, it was found that in three age groups there is an asymmetry in the level of muscle strength - in all patients the muscles that perform the function of torso rotation on the right are weaker than the muscles on the left side. In all three groups, there was a greater statistically significant difference between the strength of the functional ability of the abdominal muscles to rotate on the left than on the right. This result indicates that even minor surgery with minor damage to muscle fibers and fascia reduces the functional capacity of the abdominal muscles. LCH leads to an asymmetry in the strength of the external and internal oblique muscles of the abdominal press - a statistically significant decrease in the functional state of these muscles on the right compared with the strength of the muscles on the left in all age groups.
 Conclusions. The low level of functional ability of the abdominal muscles of patients after LCH in the long term requires the inclusion in the protocols of rehabilitation physical therapy and occupational therapy. Accordingly, physical therapy and occupational therapy programs at this stage should include techniques to increase the strength of the abdominal muscles, due to the postponed surgery, recovery and improvement of motor capacity.

Hemodynamics and vasopressor support during targeted temperature management after cardiac arrest with non-shockable rhythm: A post hoc analysis of a randomized controlled trial

BackgroundPatients admitted after cardiac arrest with non-shockable rhythm frequently experience hemodynamic instability. This study assessed the hemodynamic consequences of TTM in this sub population. MethodsThis is a post hoc analysis of the HYPERION trial (NCT01994772), that randomized patients to either hypothermia or normothermia after non-shockable rhythm related cardiac arrest. Patients with no, moderate or severe circulatory failure were identified with cardiovascular Sequential Organ Failure Assessment at randomization. Primary outcome was the number of patients at day 7 with resolution of shock, accounting for the risk of death (competing risk analysis). Secondary endpoint included neurological outcome and death at day-90. Results584 patients were included in the analysis: 195 (34%), 46 (8%) and 340 (59%) had no, moderate and severe circulatory failure, respectively. Resolution of circulatory failure at day 7 was more frequently observed in the normothermia group than in the TTM group (60% [95 %CI 54–66] versus 53% [95 %CI 46–60], Gray-test: p = 0.016). The severity of circulatory failure at randomization was associated with its less frequent resolution at day 7 accounting for the risk of death (76 % [62–86] versus 54% [49–59] for patients with moderate versus severe circulatory failure, Gray test, p < 0.001, respectively). At day 90, the proportion of patients with Cerebral Performance Category score of 1 or 2 was lower in patients presenting severe circulatory failure (p = 0.038). ConclusionCirculatory failure is frequent after CA with non-shockable rhythm. Its severity at admission and TTM were associated with delayed resolution of circulatory failure.

A newborn with anaphylaxis due to vancomycin

All drugs may cause hypersensitivity reactions. Anaphylaxis is a medical emergency that rarely occurs in newborns due to immature immunity. Early diagnosis and treatment are life-saving. Vancomycin, a glycopeptide antibiotic with bactericidal action against Gram-positive bacteria, is commonly used for neonatal nosocomial sepsis. We hereby present a premature infant (born at the 33rd week of gestation, birth weight: 1745 grams) who was started on vancomycin on postnatal day 7. He had severe circulatory failure and stridor during infusion on day 7 of vancomycin treatment and his tryptase level was elevated to 64.60 micrograms/L Conclusions. To the best of our knowledge, there is no neonatal case of anaphylaxis due to vancomycin in the literature. Neonatologists should keep in mind that an anaphylactic reaction with a fatal course may develop during vancomycin infusion.

Abstract 9963: Early Guided Palliative Communication Intervention to Optimize Family Support and Manage Expectations for Patients Receiving Extracorporeal Membrane Oxygenation (ECMO)

Introduction: Extracorporeal membrane oxygenation (ECMO) is increasingly instituted for patients with severe circulatory or respiratory failure and as bridge to recovery or destination therapies (device implantation or organ transplantation). Morbidity and mortality for those patients is high. Hypothesis: ECMO combined with COVID isolation presents an additional set of challenges for patients, families. Objective: To test feasibility of an early, concurrent, and semi-structured palliative care intervention in improving communication, clarifying goals of care, and highlighting the experience of patients’ families. Methods: IRB Approved Qualitative study using content analysis of guided, in-depth discussions with families of COVID-19 patients within 48-72 hours of being cannulated for ECMO between March- October 2020. Scripted template was developed to guide and facilitate goals of care conversations and to ensure consistent communication with family members throughout patients’ disease trajectory. Patient demographics, comorbidities, clinical course, length of stay, and discharge disposition was obtained from the institution’s COVID-19 Data Warehouse and analyzed using descriptive statistics Setting: Large urban academic medical center. Results: Patients were 44 ± 10 years, Hispanic or Latino 27/43 (63%), white 3 (7%), Black 8 (19%). Palliative care documentation for ECMO acknowledgement meeting was 36/43 (84%). Timely and guided communication demonstrated themes expressed by families including 1) social isolation and related grief of not being at patient’s bedside; 2) helping children of patients adjust to a new normal; 3) coping with multiple family members suffering from COVID-19; 4) importance of faith and spirituality; 5) need for hope and gratitude 6) futility of prolonged ECMO stay. Survival to discharge 24/43 (56%). There was no statistical difference in hospital survival or length of stay between patients with and without documented palliative care. Conclusions: Early and ongoing palliative care intervention is feasible to support families’ acknowledgment of complexity, benefits and limitations of ECMO, and it is useful in highlighting families’ experiences, managing expectations and alleviating suffering.

Abstract 11514: Extracorporeal Membrane Oxygenation is a Feasible Life Saving Modality for Adult Patients With Neoplasms- Outcomes and Trends in the Last Two Decades

Introduction: Extracorporeal Membrane Oxygenation (ECMO) is utilized in the management of severe respiratory and circulatory failure. Advanced malignancy is a relative contraindication but the indication for ECMO in the oncologic population has not been clearly established due to the wide spectrum of malignant disease and prognoses. Hypothesis: ECMO is a feasible treatment modality in selected adult oncologic population. Method: The Extracorporeal Life Support Organization (ELSO) database was queried for patients older than 18 years with an International Classification of Diseases (ICD) code of neoplasm over the past two decades (2000-2019). The data were divided into two decades to analyze and compare the trends with background and outcomes. Results: One thousand, six hundred, and ninety-seven patients met inclusion criteria from the last decade which is more than 15 times the number from the previous decade (n=110). Compared with the previous decade, ECMO was used more in patients with older age (56 vs 50.5 years old; p&lt;0.001), cardiac and extracorporeal cardiopulmonary resuscitation (ECPR) support type (p = 0.001), higher P/F ratio (79.0 vs 61.8; p=0.001), and lower oxygenation index (23.0 vs 35.6; p&lt; 0.001) in the last decade. Although survival did not show significant improvement overall (38.9% [660 of 1697] vs 33.6% [37 of 110]; p=0.272), survival in pulmonary ECMO has significantly improved in the last decade (41.6% [409 of 983] vs 29.1% [23 of 79]; p=0.030). Diagnosis of hematologic malignancy, ECPR, and hematopoietic stem cell transplant were identified as predictors of poor prognosis (p = 0.025, &lt;0.001, and 0.021 respectively). Conclusion: Utilization of ECMO for patients with neoplasms has increased over time mirroring the overall increase of adult ECMO. With careful patient selection, ECMO can be successful in oncologic population.

Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

BackgroundHigh levels of arterial oxygen pressures (PaO2) have been associated with increased mortality in extracorporeal cardiopulmonary resuscitation (ECPR), but there is limited information regarding possible mechanisms linking hyperoxia and death in this setting, notably with respect to its hemodynamic consequences. We aimed therefore at evaluating a possible association between PaO2, circulatory failure and death during ECPR.MethodsWe retrospectively analyzed 44 consecutive cardiac arrest (CA) patients treated with ECPR to determine the association between the mean PaO2 over the first 24 h, arterial blood pressure, vasopressor and intravenous fluid therapies, mortality, and cause of deaths.ResultsEleven patients (25%) survived to hospital discharge. The main causes of death were refractory circulatory shock (46%) and neurological damage (24%). Compared to survivors, non survivors had significantly higher mean 24 h PaO2 (306 ± 121 mmHg vs 164 ± 53 mmHg, p < 0.001), lower mean blood pressure and higher requirements in vasopressors and fluids, but displayed similar pulse pressure during the first 24 h (an index of native cardiac recovery). The mean 24 h PaO2 was significantly and positively correlated with the severity of hypotension and the intensity of vasoactive therapies. Patients dying from circulatory failure died after a median of 17 h, compared to a median of 58 h for patients dying from a neurological cause. Patients dying from neurological cause had better preserved blood pressure and lower vasopressor requirements.ConclusionIn conclusion, hyperoxia is associated with increased mortality during ECPR, possibly by promoting circulatory collapse or delayed neurological damage.

Covid-19 morbidity and outcomes among the patients observed in the pulmonary hypertension reference center

Abstract Background Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are progressive condition with high mortality rate despite modern pharmacotherapy. There is no reliable data concerning influence of Covid-19 infection on PAH and CTEPH morbidity and mortality. Aim To evaluate influence 12-month Covid-19 pandemic presence on morbidity and mortality in patients with PAH and CTEPH observed in PH reference center. Methods During the 12 months (from March 2020 to March 2021) we closely follow-up the condition of 404 initially alive patients with on PAH and CTEPH with specific PH therapy who were observed in our reference center for adults. All information was checked and confirmed with proper medical documents and Covid-19 diagnosis was confirmed with positive PCR or/and serological tests. We finished our database with the vaccination beginning. Results Main data are presented in table. Among 404 patients symptomatic Covid-19 infection was documented in 44 (10,9%) cases. Only 9 (20,5%) of them were hospitalized because this reason, 4 patients of them (9,1% from all Covid-19 diagnosis and 44,4% from hospitalized) needed ICU because severe circulatory and respiratory failure. All of them needed the ventilator support. Unfortunately, despite of the necessary measures all of the ICU admitted patients died shortly during couple of days (mean 2,5±1,8). There was no difference in demographic, diagnosis and initial condition between hospitalized and ambulatory treated patients. The small numbers of died patients did not allow to make any statistically significant assumption. Conclusion During 12-months Covid-19 pandemic presence 11% of PAH and CTEPH patients had symptomatic COVID-19 infection, roughly 20% of them needed hospital admission and 10% needed ICU and ventilator support. The mortality in ICU was 100%. Funding Acknowledgement Type of funding sources: None. Table 1. Covid-19 morbidity and mortality among PAH and CTEPH patients

Extracorporeal Membrane Oxygenation in Children With Cancer or Hematopoietic Cell Transplantation: Single-Center Experience in 20 Consecutive Patients.

Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for severe respiratory and/or circulatory failure. Few data exist on the potential benefit of ECMO in immunocompromised pediatric patients with cancer and/or hematopoietic cell transplantation (HCT). Over a period of 12 years, eleven (1.9%) of 572 patients with new diagnosis of leukemia/lymphoma and nine (3.5%) of 257 patients post allogeneic HCT underwent ECMO at our center. Five (45%) and two (22%) patients, respectively, survived to hospital discharge with a median event-free survival of 4.2 years. Experiences and outcomes in this cohort may aid clinicians and families when considering ECMO for individual patients.

Developmental Toxicity of Few-Layered Black Phosphorus toward Zebrafish.

Black phosphorus (BP) has extensive applications in various fields. The release of BP into aquatic ecosystems and the potential toxic effects on aquatic organisms are becoming major concerns. Here, we investigated the developmental toxicity of few-layered BP toward the zebrafish. We found that BP could adsorb on the surface of the chorion and could subsequently penetrate within the embryo. After exposure of embryos to 10 mg/L BP, developmental malformations appeared at 96 hpf, especially heart deformities such as pericardial edema and bradycardia, accompanied by severe circulatory system failure. Using transgenic zebrafish larvae, we further characterized cardiovascular defects with cardiac enlargement and impaired cardiac vessels as indicators of damage to the cardiovascular system upon BP exposure. We performed transcriptomic analysis on zebrafish embryos treated with a lower concentration of 2 mg/L. The results showed disruption in genes associated with muscle development, oxygen involved processes, focal adhesion, and VEGF and MAPK signaling pathways. These alterations also indicated that BP carries a risk of developmental perturbation at lower concentrations. This study provides new insights into the effects of BP on aquatic organisms.

Platelet Functions During Extracorporeal Membrane Oxygenation. Platelet–Leukocyte Aggregates Analyzed by Flow Cytometry as a Promising Tool to Monitor Platelet Activation

Extracorporeal membrane oxygenation (ECMO) is an extracorporeal circulation used to manage patients with severe circulatory or respiratory failure. It is associated with both high bleeding and thrombosis risks, mainly as a result of biomaterial/blood interface phenomena, high shear stress, and complex inflammatory response involving the activation of coagulation and complement systems, endothelial cells, leukocytes, and platelets. Besides their critical role in hemostasis, platelets are important players in inflammatory reactions, especially due to their ability to bind and activate leukocytes. Hence, we reviewed studies on platelet function of ECMO patients. Moreover, we addressed the issue of platelet–leukocyte aggregates (PLAs), which is a key step in both platelet and leukocyte activation, and deserves to be investigated in these patients. A reduced expression of GPIb and GPVI was found under ECMO therapy, due to the shedding processes. However, defective platelet aggregation is inconsistently reported and is still not clearly defined. Due to the high susceptibility of PLAs to pre-analytical conditions, defining and strictly adhering to a rigorous laboratory methodology is essential for reliable and reproducible results, especially in the setting of complex inflammatory situations like ECMO. We provide results on sample preparation and flow cytometric whole blood evaluation of circulating PLAs.

Peculiarities of the clinical course of frederick's syndrome on the background of comorbid pathology in the absence of adequate therapy

Atrial fibrillation in old people is one of the most common causes of cardiac decompensation. It can also lead to sudden cardiac death and thromboembolism of vital organs. Comorbidities such as diffuse cardiosclerosis, myocarditis or cardiomyopathy, congenital or acquired defects of the valvular apparatus of the heart, pathology of the endocrine system, chronic obstructive diseases of the bronchopulmonary apparatus, malignant course of arterial hypertension or its refractoriness to therapy, uncontrolled intake of antiarrhythmic drugs, can complicate the course of atrial fibrillation the addition of a transverse atrioventricular block, which is called Frederick’s syndrome. This article presents a case of clinical observation of an uncontrolled course of atrial fibrillation with the subsequent development and progression of severe circulatory failure against the background of the addition of complete atrioventricular block. Such an important factor as adherence to medical recommendations can compensate for various pathological conditions for a long time without causing significant harm to health, which was neglected by the patient from the clinical case under consideration. The launched course of arterial hypertension probably launched a cascade of morphological changes in the structures of the heart, which subsequently led to the formation of atrial fibrillation, the development of heart failure, and the addition of complete atrioventricular block. The appearance of rhythm in the heart rate, which is characteristic of this conduction disturbance, is often perceived as an erroneous restoration of the rhythm in case of pre-existing atrial fibrillation; this can complicate the timely diagnosis of pathology, especially in the absence of syncope conditions characteristic of complete atrioventricular blockade. The risks of thromboembolic complications and sudden cardiac death are as high as those associated with isolated atrial fibrillation. During the examination of the patient, the absolute indications for transplantation of an artificial pacemaker were determined. Subsequently, an increase in the minute volume of blood and cardiac output, as expected, led to an improvement in the clinical course of the disease and well-being, however, the pre-existing hemodynamic disorder of a long-term nature in this patient led to irreversible decompensation of cardiac activity, which adversely affects the long-term prognosis for life.

Application of functional load procedures in the deadly disabled persons for evaluation of indicators of the cardiovascular system at the steps of prosthetics

The problem of prosthetics of elderly patients (EP)has worsened due to the growing number of disabled people in the Russian Federation (RF), the aging of the population. Annually in RF, about 10,000 surgical interventions are performed in the case of lesions of the arteries of the lower extremities. The number of EP who need prosthetic supplies has increased. To individualize the selection of technical means of rehabilitation (TMR), at the stages of learning to walk and use prostheses, it is necessary to conduct optimal functional tests (FT). Selection of the optimal FT with load in EP who underwent amputation at the level of the shin and thigh. We examined 54 patients who underwent at the level of the lower leg and thigh. Studies were carried out with modeling of the load using manual bicycle ergometry. A universal variant of the loading test is developed, the most informative for assessing the physical state of EP, identifying potentially dangerous rhythm disturbances and painless myocardial ischemia. All samples were monitored by electrocardiography, pulse oximetry. Severe circulatory failure (CF) was detected in 7 patients (12.9%), persistent moderate in 35 patients (64.8%), insignificant in 12 patients (22.3%). Patients with severe CF prosthetics were not performed, due to low FT and a high risk of complications in the stages of prosthetics. Patients with mild CF after choosing conservative treatment were successfully prosthetized. In the remaining 12 patients the results of FT with exercise helped to start prosthetics in the early period. The use of functional stress tests in disabled patients for assessment of the cardiovascular system at the stages of prosthetics, as well as adaptation to new living conditions, allows individualizing the selection of TMR, eliminating the risks of complications at the stages of prosthetics, and shortening the terms of rehabilitation.

Long-Term Survival and Causes of Late Death in Children Treated With Extracorporeal Membrane Oxygenation.

Extracorporeal membrane oxygenation has been used in patients with severe circulatory or respiratory failure since the 1970s, but the knowledge on long-term survival in this group is scarce. The aim of the present study was to investigate the 10-year survival rates and causes of late death in children treated with extracorporeal membrane oxygenation. Single-center, retrospective cohort study. Tertiary referral center for extracorporeal life support. Neonatal and pediatric patients treated with extracorporeal membrane oxygenation from 1987 to December 2013. None. Survival status was obtained from the national Causes of Death registry. Patient background data along with data on survival and causes of death were collected. Survival rates were calculated using the Kaplan-Meier method. Of 400 subjects, 76% survived to discharge. The median follow-up time in survivors was 7.2 years. There was a high mortality rate within the first months after discharge. In the group of patients who survived the first 90 days after treatment, the 10-year survival rates were 93% in neonates and 89% in pediatric patients and were particularly beneficial in patients whose indication for extracorporeal membrane oxygenation was meconium aspiration syndrome, trauma, or infectious diseases. Late deaths were seen in some diagnostic groups, but the Kaplan-Meier curves plateaued over time. Children who survive the first months after treatment with extracorporeal membrane oxygenation have a high long-term survival rate. The prognosis is especially favorable in patients with reversible conditions.

The Hemodynamic Burden of Femoral Extracorporeal Life Support for Severe Circulatory Failure: Investigating Competing Flow Phenomena with Color Doppler Sonography

The Hemodynamic Burden of Femoral Extracorporeal Life Support for Severe Circulatory Failure: Investigating Competing Flow Phenomena with Color Doppler Sonography