Primjena ECMO aparata u liječenju kardioloških bolesnika odrasle populacije

master's thesis

• Title (english): Use of ECMO devices in treatment of adult cardiac patients
• Author: Marija Velkovski
• Mentor: Boris Starčević (mentor)
• Committee member: Željko Sutlić (predsjednik povjerenstva)
• Committee member: Igor Rudež (član povjerenstva)
• Committee member: Boris Starčević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2018-03-06, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Ekstrakorporalna membranska oksigenacija (ECMO) modificirana je vrsta kardiopulmonalne premosnice. Koristi se kao privremena potpora bolesnicima s oštećenom respiracijskom i/ili srčanom funkcijom. Da bi njena upotreba bila indicirana, zatajivanje respiracijske i srčane funkcije mora biti akutno, potencijalno reverzibilno te otporno na konvencionalne mjere liječenja, a bolesnikov mortalitetni rizik veći od 50%. Osnovni dijelovi ECMO uređaja jesu membranski oksigenator, pomoću kojeg se krv difuzijom preko polupropusne membrane oksigenira, a ugljikov dioksid uklanja, i pumpa za krv, pomoću koje se održava adekvatan protok krvi kroz ECMO sustav. ECMO potpora uspostavlja se kanilacijom bolesnikovoga cirkulacijskog sustava, koja može biti središnja i periferna. Dvije su osnovne vrste ECMO sustava, VA-ECMO i VV ECMO modalitet. VA-ECMO modalitet najčešće koristi u kardiotorakalnoj kirurgiji, jer za razliku od VV-ECMO potpore, uz respiratornu pruža i potporu kardiovaskularnom sustavu, VV-ECMO modalitet preferirana je potpora bolesnicima s teškim respiracijskim zatajivanjem zbog manjeg rizika od pojave komplikacija. Komplikacije vezane uz ECMO sustav relativno su česte, a mogu se podijeliti na mehaničke i medicinske komplikacije. Najčešće medicinske komplikacije čine hemoragijske komplikacije, dok je najčešća mehanička komplikacija je stvaranje tromba unutar ECMO sustava. Kako bi se spriječilo stvaranje tromba svi bolesnici na ECMO potpori moraju primati kontinuiranu antikoagulacijsku terapiju. Održavanje antikoagulacije i kontinuirani monitoring najvažniji su elemenati skrbi o bolesnicima na ECMO potpori, koja uključuje sve preventivne, dijagnostičke i terapijske mjere. Bolesnikov klinički status se svakodnevno razmatra i na temelju njega donosi konačna odluka o skidanju sa ECMO potpore.

Abstract (english)

Extracorporeal membrane oxygenation (ECMO) is a modified form of cardiopulmonal bypass, used as a temporary support of patients with cardiac and/or respiratory failure. Indications for ECMO include patient´s mortality risk larger then 50% and acute, potentially reversible cardiac and/or respiratory failure refractory to all conventional therapy measures. The main components of ECMO device are membrane oxygenator, in which blood is oxygenated and CO2 is removed by diffusion through semi permeable membrane, and pump which provides adequate blood flow through ECMO circuit. ECMO support is established by central or peripheral cannulation of patient´s circulatory system. There are two types of ECMO, VA-ECMO and VV-ECMO. VA-ECMO is mainly used in cardiothoracic surgery, because unlike VV-ECMO, it provides both cardiac and respiratory support. On the other hand VV- ECMO is preferred as a support to patients with severe respiratory failure, due to its generally lower risk of complications. Complications related to ECMO are relatively common and can be mechanical or medical. While the most common medical complications are hemorrhagic, the most common mechanical complication is thrombus formation in ECMO circuit. As a prevention of thrombosis all patients on ECMO support are continuously given anticoagulation drugs. Anticoagulation monitoring and maintenance is one of the most important elements in ECMO management. ECMO management includes all preventive, diagnostic and therapeutic measures for improvement of patient´s final outcome. Patient´s clinical status is observed daily, and represents basis on which decision for weaning from ECMO is brought.

• Keywords: Ekstrakorporalna membranska oksigenacija (ECMO); VA-ECMO; VV ECMO; komplikacije; antikoagulacijska terapija
• Keywords (english): Extracorporeal membrane oxygenation (ECMO); VA-ECMO; VV ECMO; complications; anticoagulation therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:650129
• Study programme: Title: Studies in Nursing; Study programme type: university; Study level: graduate; Academic / professional title: magistar/magistra sestrinstva (magistar/magistra sestrinstva)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-03-22 08:35:58