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TÍTULO DEL CASO ECMO as a Bridge to Decision. ECMO CPR: ECMO bridge to Transplant. First case in Peru. Clinica INCA. RESUMEN Woman, 42 years. Admission diagnoses: cardiogenic shock, double mitral lesion; dilated cardiomyopathy with an ejection fraction: 15%, respiratory failure, FMO, left hemiplegia sequela (1 month before admission). Echocardiography income: compacted myocardium severely decreased heart function. Happen three episodes of ventricular fibrillation in the third no return to Spontaneous Circulation post advanced CPR. ECMO Extracorporeal CPR was performed during cardiac massage 60 '. Performing peripheral cannulation, Biomedicus-550 as ECMO and Thromboelastography console. Neurologic evaluation is performed at twelve hours on ECMO does not confirm brain death, finding vestibulo-ocular reflexes and slow corneal reflex. At 22:00 the day December 19, 2014, heart transplant was performed and the ECMO is removed. Evolve with Cardiac Output 8.38 lpm. LVEF 53%; Strain by Speckle Tracking Global -23.7%; SatO2 91%; PA 116 / 65mmHg, 80% FiO2, PaO2 63. Wake up spontaneously 8 hours post surgery. Discharged the 33 day PO, stable hemodynamics and cognitively. IMPORTANCIA DEL CASO Sudden cardiac arrest is a complex, life-threatening event requiring a multidisciplinary approach. Many strategies have been proposed over time to achieve the return of spontaneous circulation and to optimize post-resuscitation care in order to ultimately improve survival. These include medical, organizational, and technical aspects: mild hypothermia, oxygen control, regionalization to specialized post-resuscitation care centers, and ECMO. As here ECMO may be the only option for highly selected patients suffering from CA in which conventional treatment failed. PRESENTACIÓN DEL CASO Referred patient, who was admitted with diagnoses: mixed shock, respiratory failure, tastorno of sensorium. Bring history of fatigue, malaise, nausea and vomiting with urine cultures with 80,000 CFU of E coli, was being treated with amikacin unimproved, loose stools and abdominal pain so the day 12.10.2014 is hospitalized added, inflammatory reaction found in postive stool, they initiate coverage with ceftriaxone and persistent abdominal pain and oral intolerance will perform upper endoscopy, during the procedure after premedication has tachycardia and desaturation so ends the procedure in the shortest time possible but fail to show erosive gastroduodenitis, after aproximadanente procedure 01 hours later, the patient does not regain consciousness and Glasgow Coma Scale 7 and 84-89% desaturation proceed to endotracheal intubation and ventilatory support prior sedation, then presents hemodynamic instability requiring inotropic support; under these conditions is derived to another hospital where he arrived with PA 0/0, FC 138 x min, with TOT + VM, Glasgow Coma Scale 7 under sedation, dosage of PCR: 0.7, elevated transaminases, lactate 8.5-10.5, TP extended 3.36 INR, platelet 83000. Ecovision: Global contractility decreased starting inotropic support with dobutamine and NA during hoapitalizacion persistently pursuing tachycardia so it gets amiodarone and Cedilanid. Family seeks second opinion at our institution and requests moved to the same. INVESTIGACIONES En caso de ser relevante DIAGNÓSTICO DIFERENCIAL En caso de ser relevante TRATAMIENTO En caso de ser relevante RESOLUCIÓN Y SEGUIMIENTO Paciente fue dada de alta al 33 dia Postoperatorio, estable Hemodinámica y Cognitivamente. Paciente viva actualmente. DISCUSIÓN Tonna JE, Over a third of centers that submitted adult extracorporeal cardiopulmonary resuscitation cases to ELSO have performed Emergency Department ECMO. These programs are largely based at academic hospitals, new, and have low volumes. They do not have many formal inclusion or exclusion criteria, and devices and techniques are variable. Dalle Ave AL, In order to avoid the fatal error of letting a saveable patient die, safeguards are necessary. We recommend: (1) the development of internationally accepted termination of Page 1 of 3 resuscitation guidelines that would have to be satisfied prior to inclusion of patients in any uncontrolled donation after circulatory determination of death protocol, (2) the choice regarding modalities of ongoing resuscitation during transfer should be focused on the primary priority of attempting to save the life of patients, (3) only centers of excellence in life-saving resuscitation should initiate or maintain uncontrolled donation after circulatory determination of death programs, (4) assisted cardiopulmonary resuscitation should be clinically considered first before the initiation of any uncontrolled donation after circulatory determination of death protocol, and (5) there should be no discrimination in the availability of access to assisted cardiopulmonary resuscitation. Mazzeffi MA, extracorporeal cardiopulmonary resuscitation may have a role in younger adult cardiac surgery patients who experience refractory cardiac arrest. Future studies are needed to identify patients who will benefit most from extracorporeal cardiopulmonary resuscitation. PUNTOS DE APRENDIZAJE 3 a 5 puntos. Decrease the fatal mistake of allowing the death of a patient salvageable. REFERENCIAS https://www.elso.org/Portals/0/IGD/Archive/FileManager/6713186745cusersshyerdocumentselsoguidelinesforecprcases1.3.pdf IMÁGENES O FIGURAS Las imagines o figuras no deben ir en el texto. Page 2 of 3 Fecha:30/08/2016 Autor: Gonzales, Hardy1, Mogrovejo, W2. 1. Cardiovascular and Thoracic Surgeon. Heart Transplantation. ECMO. Assistance Mechanical Circulatory. Instituto Neuro Cardiovascular de las Américas (INCA). [email protected] 2. Interventional cardiologist. ECMO coordinator. Instituto Neuro Cardiovascular de las Américas (INCA). [email protected] Page 3 of 3