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10.1186/s13054-017-1655-8 http://scihub22266oqcxt.onion/10.1186/s13054-017-1655-8 C5369216!5369216!28347320     free     free     free Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=28347320&cmd=llinks): Failed to open stream: HTTP request failed! 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Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation |pdf=|usr=}}{{28347320}} gab.com Text Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation JO: Crit Care http://www.kidney.de/pget.php?&tw=1&pmid=28347320 #FOAvip Background: Despite quick implementation of reperfusion therapies, a few patients with high-risk, acute, massive, pulmonary embolism (PE) remain highly hemodynamically unstable. Others have absolute contraindication to receive reperfusion therapies. Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) might lower their right ventricular overload, improve hemodynamic status, and restore tissue oxygenation. Methods: ECMO-related complications and 90-day mortality were analyzed for 17 highly unstable, ECMO-treated, massive PE patients admitted to a tertiary-care center (2006?2015). Hospital- discharge survivors were assessed for long-term health-related quality of life. A systematic review of this topic was also conducted. Results: Seventeen high-risk PE patients [median age 51 (range 18?70) years, Simplified Acute Physiology Score II (SAPS II) 78 (45?95)] were placed on VA-ECMO for 4 (1?12) days. Among 15 (82%) patients with pre-ECMO cardiac arrest, seven (41%) were cannulated during cardiopulmonary resuscitation, and eight (47%) underwent pre-ECMO thrombolysis. Pre-ECMO median blood pressure, pH, and blood lactate were, respectively: 42 (0?106) mmHg, 6.99 (6.54?7.37) and 13 (4?19) mmol/L. Ninety-day survival was 47%. Fifteen (88%) patients suffered in-ICU severe hemorrhages with no impact on survival. Like other ECMO-treated patients, ours reported limitations of all physical domains but preserved mental health 19 (4?69) months post-ICU discharge. Conclusions: VA-ECMO could be a lifesaving rescue therapy for patients with high-risk, acute, massive PE when thrombolytic therapy fails or the patient is too sick to benefit from surgical thrombectomy. Because heparin-induced clot dissolution and spontaneous fibrinolysis allows ECMO weaning within several days, future studies should investigate whether VA-ECMO should be the sole therapy or completed by additional mechanical clot-removal therapies in this setting. Electronic supplementary material: The online version of this article (doi:10.1186/s13054-017-1655-8) contains supplementary material, which is available to authorized users. Twit Text FOAVip Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation ????Crit Care http://www.kidney.de/pget.php?&tw=1&pmid=28347320 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=28347320 #FOAvip English Wikipedia <ref>{{Cite pmid|28347320}}</ref> Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation #MMPMID28347320 Corsi F; Lebreton G; Bréchot N; Hekimian G; Nieszkowska A; Trouillet JL; Luyt CE; Leprince P; Chastre J; Combes A; Schmidt M Crit Care 2017[]; 21 (ä): ä PMID28347320show ga Background: Despite quick implementation of reperfusion therapies, a few patients with high-risk, acute, massive, pulmonary embolism (PE) remain highly hemodynamically unstable. Others have absolute contraindication to receive reperfusion therapies. Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) might lower their right ventricular overload, improve hemodynamic status, and restore tissue oxygenation. Methods: ECMO-related complications and 90-day mortality were analyzed for 17 highly unstable, ECMO-treated, massive PE patients admitted to a tertiary-care center (2006?2015). Hospital- discharge survivors were assessed for long-term health-related quality of life. A systematic review of this topic was also conducted. Results: Seventeen high-risk PE patients [median age 51 (range 18?70) years, Simplified Acute Physiology Score II (SAPS II) 78 (45?95)] were placed on VA-ECMO for 4 (1?12) days. Among 15 (82%) patients with pre-ECMO cardiac arrest, seven (41%) were cannulated during cardiopulmonary resuscitation, and eight (47%) underwent pre-ECMO thrombolysis. Pre-ECMO median blood pressure, pH, and blood lactate were, respectively: 42 (0?106) mmHg, 6.99 (6.54?7.37) and 13 (4?19) mmol/L. Ninety-day survival was 47%. Fifteen (88%) patients suffered in-ICU severe hemorrhages with no impact on survival. Like other ECMO-treated patients, ours reported limitations of all physical domains but preserved mental health 19 (4?69) months post-ICU discharge. Conclusions: VA-ECMO could be a lifesaving rescue therapy for patients with high-risk, acute, massive PE when thrombolytic therapy fails or the patient is too sick to benefit from surgical thrombectomy. Because heparin-induced clot dissolution and spontaneous fibrinolysis allows ECMO weaning within several days, future studies should investigate whether VA-ECMO should be the sole therapy or completed by additional mechanical clot-removal therapies in this setting. Electronic supplementary material: The online version of this article (doi:10.1186/s13054-017-1655-8) contains supplementary material, which is available to authorized users. äLife-threatening massive pulmonary embolism rescued by venoarterial-ex(epmc).pdf DeepDyve Pubget Overpricing