Leonardo Salazar

Setting Up an ECMO Program in a South American Country: Outcomes of the First 104 Pediatric Patients.

Background: Less than 1% of the extracorporeal life support organization (ELSO) registry patients are from South America. Extracorporeal membrane oxygenation (ECMO) is an expensive therapy not only in terms of direct financial cost but also with respect to technical and human resources. Finding a successful ECMO model that developing countries can afford is critical to the expansion of therapy to include the availability of this technology for patients in the developing world. Methods: We retrospectively studied the first 104 pediatric ECMO patients in the Fundacion Cardiovascular de Colombia between May 2007 and May 2013. We collected the ELSO registry data from electronic medical records to determine the survival rate, mortality risk factors, and complications in pediatric patients who received ECMO support for cardiac failure, respiratory failure, or ECMO for extracorporeal cardiopulmonary resuscitation in the setting of refractory cardiopulmonary resuscitation. We describe our model of ECMO care regarding staff, training process, care protocol, ECMO circuit, and costs. Results: Of 104 patients, 82 were diagnosed with congenital heart disease. Of those, 50 had biventricular and 32 had univentricular physiology, with a significantly higher survival rate at discharge in the biventricular group (44% vs 18.7%, odds ratio [OR] 3.6, 95% confidence interval [CI] = 1.28-10.52, P = .01). Pediatric patients with a cardiac indication had survival rates of 76.3% at weaning and 52.6% at discharge, which is roughly comparable to those reported by the ELSO in 2013. Univentricular physiology, ECPR, severe pre-ECMO acidosis, ECMO-associated renal failure, and duration of ECMO support were factors associated with increased mortality. Conclusion: Despite limited availability of technical and economic resources, ECMO therapy can be done successfully in a developing country. A model of care based on nurses as ECMO specialists, supported by a multidisciplinary team, is cost-effective.

Extracorporeal Membrane Oxygenation in Dengue, Malaria, and Acute Chagas Disease

Extracorporeal membrane oxygenation (ECMO) is widely used in acute respiratory distress syndrome (ARDS) and myocarditis. Severe vector-mediated diseases may be complicated by ARDS or myocarditis, which are both associated with a high mortality rate. We present six cases of severe dengue, malaria, and acute Chagas disease that were treated with ECMO from September 2007 to September 2015. Patients included two pediatric and four adults (aged 12–48). Survival to decannulation was 83% and to discharge was 66%. Overall, the mean duration on ECMO was 25.4 days. We conclude that ECMO treatment can be beneficial in patients with severe dengue, malaria, and acute Chagas disease, if complicated by pulmonary or cardiac complications.

Tratamiento endovascular del aneurisma de aorta descendente en el adolescente con síndrome de Marfan: Reporte de un caso

Se expone el caso de un adolescente de 14 anos de edad, con sindrome de Marfan y antecedente de tres cirugias cardiovasculares previas: valvuloplastia aortica y mitral a los cinco anos y valvuloplastia aortica y reconstruccion de la aorta toracica con tubo de pericardio bovino a sus diez anos. En primer tiempo quirurgico se realizo reemplazo valvular aortico por valvula mecanica y valvuloplastia mitral y tricuspidea, y en segundo tiempo quirurgico, durante la misma hospitalizacion, exclusion endovascular de aneurisma de aorta descendente asintomatico sin complicaciones. Antes del egreso se diagnostico una endofuga tipo II que se manejo con observacion clinica. Luego de un ano del procedimiento, los controles clinico y tomografico son satisfactorios.