Extracorporeal membrane oxygenation, also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an
adequate amount of gas exchange or perfusion to sustain life. The technology for ECMO is largely derived from cardiopulmonary bypass, which provides shorter-term support with arrested native circulation.
This intervention has mostly been used on children, but it is seeing more use in adults with cardiac and respiratory failure. ECMO works by removing blood from the person's body and artificially removing the carbon dioxide and oxygenating red blood cells. Generally, it is used either post-cardiopulmonary bypass or in late stage treatment of a person with profound heart and/or lung failure, although it is now seeing use as a treatment for cardiac arrest in certain centers, allowing treatment of the underlying cause of arrest while circulation and oxygenation are supported.
This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.
This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.
A brief yet comprehensive coverage of ICU role in ECMO cases. Presentation has been prepared in order to help ICU fellows and registrars to understand the importance of their role and to know necessary actions they have to take in case of need.
ECMO, DEFINITION, ETIOLOGY, INDICATION, CONTRAINDICATION, TYPES OF ECMO, VENOVENOUS ECMO, VENO ARTERIAL ECMO, NURSING CARE OF PATIENT ON ECMO, WEANING FROM ECMO,
A Case Report of Hypothermia Rescued by Veno-Arterial Extracorporeal Membrane...semualkaira
Severe hypothermia is a life-threatening condition that often causes hemodynamic instability or cardiac arrest
and carries a high risk of mortality. The use of VA-ECMO in this
indication has greatly improved the prognosis of patients.
A brief yet comprehensive coverage of ICU role in ECMO cases. Presentation has been prepared in order to help ICU fellows and registrars to understand the importance of their role and to know necessary actions they have to take in case of need.
ECMO, DEFINITION, ETIOLOGY, INDICATION, CONTRAINDICATION, TYPES OF ECMO, VENOVENOUS ECMO, VENO ARTERIAL ECMO, NURSING CARE OF PATIENT ON ECMO, WEANING FROM ECMO,
A Case Report of Hypothermia Rescued by Veno-Arterial Extracorporeal Membrane...semualkaira
Severe hypothermia is a life-threatening condition that often causes hemodynamic instability or cardiac arrest
and carries a high risk of mortality. The use of VA-ECMO in this
indication has greatly improved the prognosis of patients.
A Case Report of Hypothermia Rescued by Veno-Arterial Extracorporeal Membrane...semualkaira
Severe hypothermia is a life-threatening condition that often causes hemodynamic instability or cardiac arrest
and carries a high risk of mortality. The use of VA-ECMO in this
indication has greatly improved the prognosis of patients.
A Case Report of Hypothermia Rescued by Veno-Arterial Extracorporeal Membrane...semualkaira
Severe hypothermia is a life-threatening condition that often causes hemodynamic instability or cardiac arrest and carries a high risk of mortality. The use of VA-ECMO in this indication has greatly improved the prognosis of patients
A Case Report of Hypothermia Rescued by Veno-Arterial Extracorporeal Membrane...semualkaira
Severe hypothermia is a life-threatening condition that often causes hemodynamic instability or cardiac arrest and carries a high risk of mortality. The use of VA-ECMO in this indication has greatly improved the prognosis of patients
A Case Report of Hypothermia Rescued by Veno-Arterial Extracorporeal Membrane...semualkaira
Severe hypothermia is a life-threatening condition that often causes hemodynamic instability or cardiac arrest
and carries a high risk of mortality. The use of VA-ECMO in this
indication has greatly improved the prognosis of patients
Veno-Arterial Ecmo (VA-ECMO) & Their basicGunalan M.M
VA ECMO stands for Venoarterial Extracorporeal Membrane Oxygenation. It's a life-saving medical procedure used in critical situations where the heart and lungs are unable to function adequately. VA ECMO involves diverting blood from the body, oxygenating it outside the body, and then returning it to the arterial system, effectively bypassing the heart and lungs. This allows time for the organs to rest and heal, supporting patients with severe cardiac or respiratory failure.
A study to assess the effectiveness of structured teaching program on knowledge regarding care of patients after cardiac surgery among staff nurses at Shree Narayana, Hospital, Raipur, chhattisgarh.
a clinical syndrome that results from inadequate tissue perfusion.
Hypovolemic shock - Blood or fluid loss, both leading to a decreased circulating blood volume, diastolic filling pressure, and volume.
Cardiogenic shock - due to cardiac pump failure related to loss of myocardial contractility/functional myocardium or structural/mechanical failure of the cardiac anatomy and characterized by elevations of diastolic filling pressures and volumes
Extra-cardiac/obstructive shock - due to obstruction to flow in the cardiovascular circuit and characterized by either impairment of diastolic filling or excessive afterload
Distributive shock - caused by loss of vasomotor control resulting in arteriolar/venular dilatation leading to a decrease in preload, with decreased, normal, or elevated cardiac output, depending on the presence of myocardial depression.
Similar to Ecmo (Extracorporeal membrane oxygenation) (20)
Normal cell metabolism depends on the maintenance of blood pH within very narrow limits (7.35-7.45).
Even relatively mild excursions outside this normal pH range can have deleterious effects. ABG is most frequently performed on critically ill patients to assess acid base status of patients.
Acute kidney injury (AKI) is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days.It's most common in those who are critically ill and already hospitalized.
continuous or intermittent monitoring of heart activity, generally by electrocardiography, with assessment of the patient's condition relative to their cardiac rhythm.
The inflammation of the heart muscles, such as myocarditis, the membrane sac which surrounds the heart called as pericarditis, and the inner lining of the heart or the myocardium, heart muscle as endocarditis are known as the inflammatory heart diseases.
India has launched 11 five year plans so far and 12th is in progress.DescriptionThe NITI Aayog is a policy think tank of the Government of India, established with the aim to achieve Sustainable Development Goals and to enhance cooperative federalism by fostering the involvement of State Governments of India in the economic policy-making process using a bottom-up approach.
Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.
Cardiac monitoring generally refers to continuous or intermittent monitoring of heart activity, generally by electrocardiography, with assessment of the patient's condition relative to their cardiac rhythm.
Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement — is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
3. HISTORY
John Heysham Gibbon
1937- successful on cats
1953- first successful open heart
surgery by using cardiopulmonary
bypass
Robert Bartlett
1976- First neonatal survivor of ECMO
(Esperanza)
4. DEFINITION
ECMO is a form of extracorpeal life support where an external artificial
circulator carries venous blood from the patient to a gas exchange device
(oxygenator) where blood becomes enriched with oxygen and has carbon
dioxide removed. This blood then re-enters the patient’s circulation. Circuit
flow is achieved using a pump either centrifugal or a roller pump.
ECMO is evolved from cardiopulmonary by-pass.
5. INDICATIONS
Guidelines that describe the indications and practice of ECMO are published by the
Extracorporeal Life Support Organization (ELSO). Criteria for the initiation of ECMO
vary by institution, but generally include acute severe cardiac or pulmonary failure
that is potentially reversible and unresponsive to conventional management.
Respiratory failure
ALI/ARDS
Aspiration Pneumonia
Asthma
Post lung transplant
Lung contusion
Cardiac Failure
Post cardiac arrest
Pulmonary embolus
Drug overdose
Post cardiac surgery
Bridge to transplant
Post heart transplant
Cardiogenic shock
6. CONTRAINDICATIONS
Absolute Contraindications
Severe irreversible neurological condition
Encephalopathy
Cirrhosis with ascites
History of variceal bleeding
Moderate-severe chronic lung disease
Terminal malignancy
HIV
VENO-
VENOUS ECMO
Severe left
ventricular
failure EF
<25%
Cardiac arrest
VENO –
ARTERIAL ECMO
Aortic
dissection
Severe aortic
regurgitation
7. CONTRAINDICATIONS
VENO-
VENOUS ECMO
High pressure/
high Fio2 IPPV
for > 1 week
VENO –
ARTERIAL ECMO
Severe
peripheral
vascular
disease
Relative Contraindications
Age >65
Multiple trauma with uncontrolled haemorrhage
Multi-organ failure
22. COMPLICATIONS
Neurologic
*neurological injury which may include intracerebral hemorrhage, subarachnoid hemorrhage, ischemic infarctions
in susceptible areas of the brain, hypoxic-ischemic encephalopathy, unexplained coma, and brain death.
*Bleeding (occurs in 30 to 40 percent) due to both the necessary continuous heparin infusion and platelet
dysfunction.
Blood
Heparin-induced thrombocytopenia
Thrombosis.
Bridge to assist device
A variety of complications can occur during cannulation, including vessel perforation with bleeding, arterial
dissection, distal ischemia
In Children, there is high risk for intraventricular hemorrhage
23. NURSING MANAGENMENT
The ECMO patient must NOT be left unattended at any time. Relief for breaks should be
arranged so that a suitably experienced member of staff is monitoring the patient and
ECMO circuit at all times.
Patient should be nursed in the supine position. Head of bed can be elevated to 30 degrees.
Pressure relieving mattress should be insitu (because of decreased mobility and perfusion
these patients are often at high risk for pressure areas)
24. NURSING MANAGENMENT
Hourly observations include
Pump flow rate
Nursing ECMO observation chart must be maintained
Haemodynamic observations- Continuously monitor patient and ECMO set for drop in BP/ CVP
Evidence of hypovolaemia in the form of fluctuating flow rates and ‘shaking’ of ECMO tubes
Hypovolaemia (relative or absolute) may result in disrupted blood flow through the circuit
Sucking down of the access cannula against the vessel wall may occur in hypovolaemia
potentially causing trauma to vessel endothelium and haemolysis
Blood flow through the ECMO circuit is essential for maintenance of gaseous exchange, and also
to maintaining haemodynamic stability
Oxygen flow to oxygenator
Patient temperature
25. NURSING MANAGENMENT
Access & return cannula for bleeding
Observe for oozing of blood, and maintain secure dressings
Secure dressings are required to maintain cleanliness of cannula sites, and also to help stabilise
the cannula
Circulation observations especially on lower limbs
Limb temperature
Limb colour
Pedal pulses
Capillary refill -Due to the large bore cannula distal arterial perfusion may be compromised in A-
VECMO, while the venous cannula may lead to DVT formation
Input & output-Haematuria is often present when there is haemolysis, and therefore should be
reported and investigated appropriately
26. RESEARCH AND ABSTRACT
Yun Zhan, Chun-Sheng Li, XiaoLi Yuan, JiYang Ling, Qiang Zhang, Yong Liang, Bo Liu, Lian-Xing Zhao: Bioscience Reports
Jul 19, 2019,39(7)
ECMO attenuates inflammation response and increases ATPase activity in brain of swine model with cardiac arrest compared
with CCPR
Abstract
Extracorporeal membrane oxygenation (ECMO) could increase survival rate and neurological outcomes of cardiac arrest (CA)
patients compared with conventional cardiopulmonary resuscitation (CCPR). Currently, the underlying mechanisms how ECMO
improves neurological outcomes of CA patients compared with CCPR have not been revealed. A pig model of CA was established
by ventricular fibrillation induction and then underwent CCPR or ECMO. Survival and hemodynamics during the 6 h after return
of spontaneous circulation (ROSC) were compared. The levels of inflammatory cytokines and Ca2+-ATPase and NA+-K+-
ATPase activities were detected. Brain tissues histology and ultra-microstructure in CCPR and ECMO groups were also
examined.
27. RESEARCH AND ABSTRACT
Results suggested that ECMO significantly improved the survival of pigs compared with CCPR. Heart rate (HR) decreased
while cardiac output (CO) increased along with the time after ROSC in both ECMO and CCPR groups. At each time point, HR
in ECMO groups was lower than that in CCPR group while CO and mean arterial pressure in ECMO group was higher than
CCPR group. In ECMO group, lower levels of IL-1, IL-1β, IL-6, TNFα, and TGFβ, especially IL-1, IL-6, TNFα, and TGFβ,
were found compared that in CCPR group while no difference of IL-10 between the two groups was observed. Similar with the
results from enzyme-linked immunosorbent assay, decreased expressions of IL-6 and TGFβ were also identified by Western
blotting. And Ca2+-ATPase and NA+-K+-ATPase activities were increased by ECMO compared with CCPR. Hematoxylin and
eosin staining and ultra-microstructure examination also revealed an improved inflammation situation in ECMO group
compared with CCPR group.
28. SUMMARY
Extracorporeal membrane oxygenation, also known as extracorporeal life support (ECLS), is an
extracorporeal technique of providing prolonged cardiac and respiratory support to persons
whose heart and lungs are unable to provide an adequate amount of gas exchange or perfusion
to sustain life. The technology for ECMO is largely derived from cardiopulmonary bypass, which
provides shorter-term support with arrested native circulation.
This intervention has mostly been used on children, but it is seeing more use in adults with
cardiac and respiratory failure. ECMO works by removing blood from the person's body and
artificially removing the carbon dioxide and oxygenating red blood cells. Generally, it is used
either post-cardiopulmonary bypass or in late stage treatment of a person with profound heart
and/or lung failure, although it is now seeing use as a treatment for cardiac arrest in certain
centers, allowing treatment of the underlying cause of arrest while circulation and oxygenation
are supported.
29. CONCLUSION
Even though ECMO is used for a range of conditions with varying
mortality rates, early detection is key to prevent the progression of
deterioration and increase survival outcomes. ECMO has also seen
its use on cadavers as being able to increase the viability rate of
transplanted organs.
30. BIBLIOGRAPHY
Guyton, AC & Hall, JE 2010, Textbook of Medical Physiology, 12th edition, W.B. Saunders Company,
Philadelphia
Luo, Wang, Hu, Gao, Long, Song,(2009). Extracorporeal membrane oxygenation for treatment of cardiac
failure in adult patients. Interactive CardioVascular and Thoracic Surgery, 9: 296-300.
Tortora, G. & Grabowski, S.R., 2003, Principles of Anatomy and Physiology, 10th ed, John Wiley & Sons,
Inc, New York.
https://www.aci.health.nsw.gov.au
https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation
https://www.annalsthoracicsurgery.org/article/S0003-4975(03)01816-2