Publications by authors named "Dinis dos Reis Miranda"
Background: Critical care of patients on extracorporeal membrane oxygenation (ECMO) with acute brain injury (ABI) is notable for a lack of high-quality clinical evidence. Here, we offer guidelines for neurological care (neurological monitoring and management) of adults during and after ECMO support.
Methods: These guidelines are based on clinical practice consensus recommendations and scientific statements.
Article Synopsis
- - The text discusses the lack of strong clinical evidence in the critical care of ECMO patients with acute brain injury (ABI) and presents guidelines for their neurological care.
- - Guidelines were developed using input from an international panel of 30 ECMO experts through a structured voting process, focusing on five key clinical areas.
- - The consensus emphasizes the importance of early detection and intervention for ABI in ECMO patients to improve health outcomes and outlines multiple recommendations to guide clinical practice and highlight research needs.
An 18-year-old drowning victim was successfully resuscitated using prehospital veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Despite 24 min of submersion in water with a surface temperature of 15 °C, the patient was cannulated on-scene and transported to a trauma center. After ICU admission on VA-ECMO, he was decannulated and extubated by day 5.
View Article and Find Full Text PDFHealth-related quality of life one year after refractory cardiac arrest treated with conventional or extracorporeal CPR; a secondary analysis of the INCEPTION-trial.
Resusc Plus
September 2024
Article Synopsis
- A study examined health-related quality of life (HRQoL) in patients who survived out-of-hospital cardiac arrest (OHCA) treated with either extracorporeal cardiopulmonary resuscitation (ECPR) or conventional CPR (CCPR) during the first year post-incident.
- Out of 134 enrolled patients, only 20% survived to hospital discharge, with HRQoL assessed for 25 survivors using the EQ-5D-5L questionnaire, revealing 68% had good HRQoL after one year.
- Although there was no significant statistical difference in HRQoL scores between ECPR and CCPR groups, results suggested that ECPR survivors experienced numerically better outcomes,
Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study.
Crit Care Med
October 2024
Article Synopsis
- * Conducted across 34 centers globally from 2000 to 2020, the study included over 2,000 adult patients split into different ECMO duration groups, revealing higher complications and mortality rates associated with longer ECMO durations.
- * The findings suggest that while most in-hospital complications increase with ECMO duration, post-discharge survival rates remain similar across groups, with specific risk factors like age and pre-existing conditions affecting long-term survival for those on ECMO longer than 7 days.
Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used as a supportive treatment for refractory out-of-hospital cardiac arrest (OHCA). Still, there is a paucity of data evaluating favorable and unfavorable prognostic characteristics in patients considered for ECPR.
Methods: We performed a previously unplanned post-hoc analysis of the multicenter randomized controlled INCEPTION-trial.
Article Synopsis
- Bleeding and thrombotic complications are prevalent in ECMO patients, impacting mortality and morbidity; this study compares complication rates before and after a change in anticoagulation monitoring protocol.
- A retrospective cohort study involved 250 adult ECMO patients, analyzing demographics, ECMO data, and coagulation tests to evaluate the effectiveness of the aPTT guided and multimodal protocols.
- Results showed that complication rates were similar between the two protocols, and surgical interventions significantly increased the risk of both bleeding and thrombotic issues.
A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study.
Scand J Trauma Resusc Emerg Med
April 2024
Background: The likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60 min.
View Article and Find Full Text PDFCardiac arrest (CA) is a common and potentially avoidable cause of death, while constituting a substantial public health burden. Although survival rates for out-of-hospital cardiac arrest (OHCA) have improved in recent decades, the prognosis for refractory OHCA remains poor. The use of veno-arterial extracorporeal membrane oxygenation during cardiopulmonary resuscitation (ECPR) is increasingly being considered to support rescue measures when conventional cardiopulmonary resuscitation (CPR) fails.
View Article and Find Full Text PDFSurvival following cardiac arrest (CA) remains poor after conventional cardiopulmonary resuscitation (CCPR) (6-26%), and the outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) are often inconsistent. Poor survival is a consequence of CA, low-flow states during CCPR, multi-organ injury, insufficient monitoring, and delayed treatment of the causative condition. We developed a new strategy to address these issues.
View Article and Find Full Text PDFEligibility of cardiac arrest patients for extracorporeal cardiopulmonary resuscitation and their clinical characteristics: a retrospective two-centre study.
Eur J Emerg Med
April 2024
Background And Importance: Sudden cardiac arrest has a high incidence and often leads to death. A treatment option that might improve the outcomes in refractory cardiac arrest is Extracorporeal Cardiopulmonary Resuscitation (ECPR).
Objectives: This study investigates the number of in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients eligible to ECPR and identifies clinical characteristics that may help to identify which patients benefit the most from ECPR.
Introduction: A broad range of pathophysiologic conditions can lead to cardiopulmonary arrest in children. Some of these children suffer from refractory cardiac arrest, not responding to basic and advanced life support. Extracorporeal-Cardiopulmonary Resuscitation (E-CPR) might be a life-saving option for this group.
View Article and Find Full Text PDFArticle Synopsis
- Existing research on RBC transfusion in VA ECMO patients is limited, mostly consisting of small-scale studies that hinder broader understanding.
- This study involved an international survey and retrospective data collection from 16 centers to assess transfusion practices and outcomes in VA ECMO patients.
- Results showed that a high percentage of patients (89%) received RBC transfusions, with factors like lower hemoglobin and longer ECMO duration influencing the need for transfusions, but overall survival did not significantly differ based on transfusion status.
Article Synopsis
- The study examines the use of various blood products (plasma, fibrinogen concentrate, TXA, and PCC) in patients on extracorporeal membrane oxygenation (ECMO) to achieve better blood clotting balance.
- It analyzes data from a multicenter retrospective study involving adult patients on VA-ECMO and VV-ECMO, identifying complications related to bleeding and thrombosis.
- Results indicate a higher use of transfusions in patients with bleeding complications, revealing trends in treatment that suggest a need for reevaluation of current transfusion practices in ECMO patients.
The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study.
Crit Care
August 2023
Article Synopsis
- Thrombocytopenia (low platelets) and bleeding are common problems for patients on a special machine called VA ECMO that helps with heart and lung issues.
- A study looked at 419 patients and found that almost all of them developed low platelets, with many having severe cases, and more than half needed platelet transfusions.
- The research showed that having severe low platelets makes it much more likely to need a platelet transfusion, especially if the patient is also bleeding.
Prognostic modelling techniques have rapidly evolved over the past decade and may greatly benefit patients supported with ExtraCorporeal Membrane Oxygenation (ECMO). Epidemiological and computational physiological approaches aim to provide more accurate predictive assessments of ECMO-related risks and benefits. Implementation of these approaches may produce predictive tools that can improve complex clinical decisions surrounding ECMO allocation and management.
View Article and Find Full Text PDFIntroduction: In cardiac arrest, cerebral ischemia and reperfusion injury mainly determine the neurological outcome. The aim of this study was to investigate the relation between the course of cerebral oxygenation and regain of consciousness in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR). We hypothesized that rapid cerebral oxygenation increase causes unfavorable outcomes.
View Article and Find Full Text PDFArticle Synopsis
- Extracorporeal CPR is a method used to restore blood flow and oxygen to patients with cardiac arrest who don’t regain spontaneous circulation, but its effectiveness on survival and neurological outcomes is unclear.
- A randomized trial in the Netherlands compared extracorporeal CPR with conventional CPR in patients aged 18 to 70 who experienced out-of-hospital cardiac arrest and received bystander CPR.
- The results showed that after 30 days, 20% of patients in the extracorporeal CPR group had a favorable neurologic outcome compared to 16% in the conventional CPR group, indicating similar outcomes for both methods.
Article Synopsis
- - This study examines survival rates and health-related quality of life (HRQOL) in patients who underwent extracorporeal membrane oxygenation (ECMO) treatment within one year of their hospital admission.
- - Out of 428 patients, 50% died within the year, but those who survived reported a good average HRQOL of 0.71 after 12 months and incurred an average total cost of $204,513, with hospital expenses being the largest portion.
- - The findings suggest that while the quality of life for ECMO survivors is favorable, the high costs raise concerns, and potential biases in follow-up data could skew results toward better health outcomes than what might be typical.
Unlabelled: Although venovenous extracorporeal membrane oxygenation (VV ECMO) has been used in case of COVID-19 induced acute respiratory distress syndrome (ARDS), outcomes and criteria for its application should be evaluated.
Objectives: To describe patient characteristics and outcomes in patients receiving VV ECMO due to COVID-19-induced ARDS and to assess the possible impact of COVID-19 on mortality.
Design Setting And Participants: Multicenter retrospective study in 15 ICUs worldwide.
Article Synopsis
- After cardiac arrest, survival outcomes are influenced by the duration of low-flow periods during resuscitation efforts using either extracorporeal cardiopulmonary resuscitation (ECPR) or conventional cardiopulmonary resuscitation (CCPR).
- The study analyzed data from 42 observational studies, concluding that ECPR has a slower decline in survival rates over time compared to CCPR, for both adults and children.
- Overall, despite rapid declines in survival for both ECPR and CCPR, ECPR showed better short-term survival rates in relation to low-flow duration, indicating its effectiveness as a resuscitation method.