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Biomedical subjects

R K Firmin

Publications and source records attributed to R K Firmin.

At least 37 records · Page 2Linked to original sources
PubMed1998

Severe acute respiratory distress syndrome secondary to acute pancreatitis successfully treated with extracorporeal membrane oxygenation in three patients.

OBJECTIVE: To review three patients who underwent extracorporeal membrane oxygenation (ECMO) for acute respiratory failure secondary to pancreatitis. SUMMARY BACKGROUND DATA: Severe acute pancreatitis often causes the acute respiratory distress syndrome (ARDS), and if ventilation is required, the mortality rate is more than 50%. If the ratio of PaO2/FiO2 falls below 100 mm Hg or the Murray lung injury score exceeds 3.5, the mortality rate rises to more than 80%. Three patients who have severe ARDS secondary to pancreatitis, who were hypoxic despite ventilation with 100% oxygen and high airway pressures, and who were all successfully treated with ECMO are reported here. The consensus here is that all three patients would have died without ECMO. METHODS: Retrospective chart review and discussion of the literature. RESULTS: Pre-ECMO data: mean PaO2/FiO2 59.3 mm Hg, mean Murray lung injury score 3.7, one patient administered 20 ppm inhaled nitric oxide. ECMO data: mean extracorporeal flow at initiation of ECMO 56.3 mL/kg per minute, all patients administered veno-venous ECMO, mean duration of ECMO 104.7 hours. All patients were successfully weaned from ECMO and extubated. One patient had a protracted hospital stay because of a colo-cutaneous fistula. All patients are long-term survivors. CONCLUSIONS: Extracorporeal membrane oxygenation proved an effective therapy for severe ARDS complicating acute pancreatitis. Extracorporeal membrane oxygenation was conducted without bleeding complications in these three patients.

Acute Disease↗
PubMed1998

Extracorporeal membrane oxygenation: potential for adults and children?

Extracorporeal membrane oxygenation is a proven therapy for severe neonatal respiratory failure. Extracorporeal membrane oxygenation for older children and adults who are failing to respond to maximal conventional therapy is more controversial, but survival figures of 50-80% can be obtained, in patients with an expected survival of 0-20% with conventional treatment.

Adult↗
PubMed1997

Extracorporeal support for intractable cardiorespiratory failure due to meningococcal disease.

BACKGROUND: Meningococcal disease is still associated with considerable mortality, despite the use of early antibiotics and management in specialised intensive care units, due principally to early refractory myocardial depression and hypotension as well as severe acute respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) is a complex technology that uses a modified "heart-lung" machine to provide temporary cardiac and respiratory support. We reviewed the UK and Australian experience of the use of ECMO in patients with refractory cardiorespiratory failure due to meningococcal disease. METHODS: The records from all 12 known patients supported with ECMO for meningococcal disease in the UK and Australia since 1989 were reviewed. FINDINGS: 12 patients (aged 4 months to 18 years, median 26 months) with meningococcal disease received ECMO over 8 years. In seven patients, ECMO was required early for cardiac support for intractable shock within 36 h of admission to intensive care. In the other five patients, ECMO was indicated for respiratory failure due to severe adult respiratory distress syndrome, which tended to occur later in the disease. The paediatric risk of mortality score ranged from 13 to 40 (median 29, median predicted risk of mortality 72%). Six of the 12 patients required cardiopulmonary resuscitation before ECMO and the other six were deteriorating despite maximal conventional therapy. Overall, eight of the 12 patients survived, with six leading functionally normal lives at a median of 1 year (range 4 months to 4 years) of follow-up. INTERPRETATION: ECMO might be considered to support patients with intractable cardiorespiratory failure due to meningococcal disease who are not responding to conventional treatment.

Adolescent↗
PubMed1997

Extracorporeal membrane oxygenation for cardiac support.

Extracorporeal membrane oxygenation (ECMO) uses cardiopulmonary bypass technology to provide prolonged cardiac or respiratory support in the intensive care unit. The use of ECMO for neonatal respiratory failure is now good evidence-based medicine following publication of the UK Collaborative ECMO Trial, but its use in adults and children remains controversial. In this review the use of ECMO to support paediatric patients with pre- and post-operative cardiac insufficiency is discussed. The survival with ECMO in these patients is 43-61%, which is remarkable in a group of patients who are moribund prior to initiation of ECMO.

Adult↗
PubMed1997

Extracorporeal membrane oxygenation for adult respiratory failure.

OBJECTIVES: To review the first 50 patients to receive extracorporeal membrane oxygenation (ECMO) for respiratory failure at Glenfield Hospital, and to compare them with published series of patients receiving positive pressure ventilation. DESIGN: Retrospective chart review. SETTING: Extracorporeal Life Support Organization/European Extracorporeal Life Support Organization recognized ECMO center. PATIENTS: Fifty consecutive patients referred for ECMO with respiratory failure refractory to conventional management between 1989 and 1995. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Primary end point was survival to hospital discharge, 66%. Other data (mean and SD): Murray Lung Injury Score, 3.4 (0.5); ratio of PaO2 to fraction of inspired oxygen, 65 (36.9) mm Hg; duration of ventilation pre-ECMO, 76.5 (83.7 h); peak airway pressure, 39.6 (7.4) cm H2O; end-expiratory pressure, 10 (3.3) cm H2O; minute ventilation, 12.6 (3.32) L/min; age, 30.1 (10.8) years; duration of ECMO, 207.4 (177.8) h; and units of blood transfused, 19 (17.3). Survival was significantly better than two previously reported series of patients receiving positive pressure ventilation (55.6% and 42% survival), p=0.036 and p=0.0006. Odds ratio for improved survival was 0.46 (95% confidence interval, 0.22 to 0.97, p=0.036). CONCLUSIONS: Survival with ECMO is 66% for adults with severe respiratory failure. ECMO should be considered in patients who remain hypoxic despite maximal positive pressure ventilation.

Adult↗
PubMed1996

Cannulation of neonates for venovenous extracorporeal life support.

Venovenous access via a double-lumen cannula in the right internal jugular vein is the extracorporeal life support mode of choice for neonates with respiratory failure. We report a simplified method of cannulation. The advantages of this "semi-Seldinger" method include the ability to cannulate without ligating the internal jugular vein, and to adjust the position of the cannula and decannulate without re-exploring the wound.

Cardiac Catheterization↗
PubMed1995

Extracorporeal membrane oxygenation for the treatment of massive pulmonary embolism.

After witnessing the death of a patient following pulmonary embolectomy, John H. Gibbon, Jr, developed the idea of a device for extracorporeal oxygenation and circulation. What followed has led to the present-day method of extracorporeal membrane oxygenation as an effective method of cardiorespiratory support. In this case of massive acute pulmonary embolism, its use in a conscious patient completes the circle from the first ideas of Gibbon.

Acute Disease↗
PubMed1995

Isolated sternal fracture: an audit of 10 years' experience.

We have reviewed 162 consecutive cases of sternal fracture admitted to the Leicester Royal Infirmary over a 10 year period. There were no incidences of cardiogenic shock or arrhythmia developing in patients who had sustained an isolated sternal fracture, irrespective of the aetiology. There were three deaths, three ITU admissions and one arrhythmia, all occurring in patients with severe thoracic injuries, or other associated injury. Our series confirms the observations of other authors, that patients with isolated sternal fractures, especially those sustained by car occupants wearing seatbelts, do not develop myocardial pump failure or arrhythmias as a late or occult phenomenon and can often be discharged home if there is no clinical evidence of cardiac failure and a 12-lead ECG is normal.

Accidental Falls↗
PubMed1995

Extracorporeal membrane oxygenation and the treatment of critical pulmonary hypertension in congenital heart disease.

Certain forms of congenital heart disease (CHD) confer a high risk for the development of severe pulmonary hypertension before and after corrective cardiac surgery. Extracorporeal membrane oxygenation (ECMO) has theoretical benefits in the treatment of this complication in that it assures oxygenation, corrects acid-base balance and provides haemodynamic support at the same time as allowing lung rest from ventilation. We examined our experience of the 117 children and neonates supported with ECMO between November 1989 and July 1993. Of these, five received support for critical pulmonary hypertension associated with congenital heart disease. They comprised three who had undergone surgical repair of CHD, one whose total anomalous pulmonary venous drainage was diagnosed and corrected whilst on ECMO and one neonate with functional pulmonary atresia. Pulmonary artery pressure (PAP) was estimated by Doppler echocardiography in all patients and confirmed invasively in two. The median systolic PAP was 46 (range 42-65) mmHg prior to ECMO. The median ratio of pulmonary to systemic arterial pressure (PAP/SAP) was 0.75 (0.70-0.92). Following ECMO of 16-120 h duration, the median systolic PAP was 34 (30-49) mmHg with PAP/SAP 0.50 (0.35-0.60). All patients survived and there were no complications related to ECMO. Extracorporeal membrane oxygenation is an effective treatment in critical pulmonary hypertension and should be considered in all patients in whom this is refractory to conventional measures.

Acid-Base Equilibrium↗
PubMed1995

Role of ECMO in the treatment of respiratory syncytial virus bronchiolitis: a collaborative report.

AIM: To report the collaborative experience of extracorporeal membrane oxygenation (ECMO) in the treatment of respiratory syncytial virus (RSV) bronchiolitis between April 1989 and January 1995. METHODS: The medical records of patients with confirmed RSV bronchiolitis referred to three centres (Leicester, Glasgow, and Great Ormond Street) were reviewed. RESULTS: Twenty four infants were identified. Seventeen had been born prematurely (gestational range 23-40 weeks, median 30 weeks). Thirteen infants had been mechanically ventilated after birth and seven of these had evidence of bronchopulmonary dysplasia (BPD). The age of onset of RSV infection varied from three to 64 weeks (mean 17.4 weeks, median 12 weeks). Ventilation before ECMO ranged from one to 16 days and oxygenation indices at the time of referral ranged from 21-73 (mean 39). Ribavirin was used in eight of the 24 patients. Sixteen patients received venoarterial and eight veno-venous ECMO. ECMO hours ranged from 32-647 (median 196 hours). One infant died (survival rate 96%). Cranial ultrasound abnormalities were detected in three patients. However, at follow up only one of the 23 survivors had evidence of developmental delay. CONCLUSION: A group of paediatric patients in whom ECMO can be of benefit has been identified. The use of ECMO should be considered when other means of support prove unsuccessful.

Age of Onset↗