Qatar Medical Journal - 1 - Extracorporeal Life Support Organisation of the South and West Asia Chapter 2017 Conference Proceedings, February 2017

Background: Obesity, defined according to body mass index (BMI > 30 kg/m2), is an increasing problem in the world's population. The proportion of extremely obese patients (BMI > 40 kg/m2) in intensive care units varies between 2.8 and 6.8%.1 A BMI higher than 40 kg/m2 seems to be associated with an increased risk of developing acute respiratory distress syndrome (ARDS) along with greater morbidity, length of stay, and duration of Read More

Interstitial lung disease comprises a heterogeneous group of histologically distinct pathological entities characterized by a diffuse inflammatory process affecting the lung parenchyma. Classification of interstitial lung disease is complex and usually determined by a combination of clinical features, radiological, particularly computed tomography, appearance, and findings at lung biopsy. Interstitial lung disease presentations can range fro Read More

Extracorporeal membrane oxygenation (ECMO) is increasingly being used in adult patients with either cardiac or respiratory failure or both in many settings.1,2 This includes pregnant patients and those who are postpartum experiencing cardiac or respiratory failure, a particularly vulnerable population where both the mother and the fetus are at risk. There is scant literature addressing the use of ECMO for either cardiac or respira Read More

Pulmonary vasculitis is a rare disease that typically shows inflammation in pulmonary vessel walls and necrosis.1 The disease is usually immune mediated, common in young patients, triggered by many factors, and with wide clinical and radiologic presentations. Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAVs) is the main focus in most literature and includes granulomatosis with polyangiitis (GPA), microsc Read More

Pulmonary infection and respiratory failure are the most common causes of admission to the intensive care unit (ICU) in human immunodeficiency virus (HIV)-positive patients.1,2 In our experience, in a developing nation (despite the advent of HAART), the commonest cause of admission to ICU and mechanical ventilation still remains Pneumocystis jiroveci pneumonia (PJP). Most of these patients presenting with PJP have not been on antir Read More

Congenital diaphragmatic hernia (CDH) remains a common defect in infants and occurs worldwide at a rate of 0.8–4.5 per 10,000 live births. It is associated with high mortality and morbidity. Veno-arterial (VA) support remains common in neonates with CDH, although venovenous support has also been used.1 Criteria for extracorporeal membrane oxygenation (ECMO) in CDH patients remain an inexact science. Studies have evaluated t Read More

Extracorporeal membrane oxygenation (ECMO) is an increasingly used life support modality in both respiratory and cardiac cases. The ECMO run may last from a few hours to several months and is usually associated with many major and minor events that can be overseen and may not always be documented. These ECMO complications are related to the circuit, the patient, or other factors such as procedures, drugs, environment, and Read More

With the introduction of veno-venous extracorporeal membrane oxygenation (VV-ECMO) to Qatar, the medical intensive care unit (MICU) team started to face new and challenging ethical dilemmas. These ethical questions have subjected the team of physicians, nurses, and other healthcare professionals to mental stress in addition to the physical stress already encountered running the ECMO service. In this article, we reviewed th Read More

Background: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) provides the respiratory support in acute severe respiratory failure until the underlying acute lung pathology improves.1,2 VV-ECMO support for >100 days is rare and in most situations requires a destination therapy of lung transplant.3,4 This may not be an option in some centers. We had our longest ECMO case of >300 days with severe residual fibrotic lung dise Read More

Aim: Extracorporeal membrane oxygenation (ECMO) may be lifesaving for patients with severe cardiac/respiratory failure. Typically, ECMO is provided by specialized or regional centers, and patients may have to be transported by road or air ambulance. Herein, we will review the essential requirements for road transport of adult ECMO patients, also known as “mobile ECMO”. Background: Interfacility transport on ECMO is defined as “primary Read More

Transport of extracorporeal membrane oxygenation (ECMO) patients in India, where there are very few ECMO centres, is a real challenge due to the huge area and large population of the country, and the diversities of resources between urban and rural areas. Road and air transportation are well established but another common mode of transport not fully developed is the train. Road transportation is used in almost 98% of our ECMO t Read More

This study reports India's first international extracorporeal membrane oxygenation (ECMO) transfer as a joint operation between Hamad Medical Corporation (HMC) (Doha, Qatar), International Critical Care Air Transfer Team (ICATT), and Apollo Hospital (Chennai, India). Severe respiratory failure (SRF) patients can be transferred safely, and there may be a survival advantage in transferring such patients to regional centers of expertise. Read More

Background: Transport of patients on ECMO has been demonstrated to be safe, if undertaken by well-trained teams.1–3 Incorporating an Ambulance Service Critical Care Paramedic (CCP) into the team provides a seamless team dynamic during retrieval improving safety.4 The CCP helps to co-ordinate logistics, monitors patient and team safety and provides an additional resource for advanced life support during ECMO patient transport. In a Read More

Extracorporeal membrane oxygenation (ECMO) is a highly complex, resource-intensive intervention. The use of veno-venous ECMO for the management of patients with acute, reversible lung failure has increased significantly over the past 10 years.1 Advances in ECMO technology have resulted in the development of simpler, safer circuits, which are associated with fewer complications. Concomitantly with the clinical and technological chan Read More

As part of the National Health Strategy in the State of Qatar to improve the healthcare sector, the Critical Care Service in Hamad General Hospital (HGH) sets up an extracorporeal membrane oxygenation (ECMO) service within the Medical Intensive Care Unit (MICU) to enhance the care provided to critically ill patients. The new service demands a new technology and specific staff training in order to maintain high standards and safe care. Read More

Extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) is a highly specialized procedure relying on advanced technology, and specific attention is required to ensure safe operation. Who should or can accomplish this procedure is roughly defined by the ELSO guidelines.1 Before starting an ECMO program, proper assessment of resource adequacy is crucial, and developing the structure for the program is man Read More

In 2010, following the H1N1 swine flu pandemic,1 five severe respiratory centers were commissioned in England. These were established to provide veno-venous ECMO (extracorporeal membrane oxygenation) for patients with refractory respiratory failure. Moreover, it was a condition set out by the commissioning body that each center would carry out a minimum of 20 cases per year to remain certified. The reality of the situation has pr Read More

Intensive care unit-acquired weakness is a common sequela of critical illness and is associated with deficits in physical strength, functional performance, and associated health-related quality of life.1–3 Early rehabilitation in the intensive care unit (ICU) is recognised as safe and feasible.4,5 Maintaining and restoring musculoskeletal strength and function is recognised as an essential element of therapy in critical care.3 Active rehabilitation of pati Read More

The last couple of decades has brought a lot of changes in thoughts and technology in the domain of simulation-based healthcare education, ranging from emergency preparedness using screen-based technology to the practice of precise surgical procedures with computerised simulators with haptic and performance feedback.1 There is a perpetually evolving educational and technological simulation continuum available to educators and Read More

Transfer and retrieval of extracorporeal membrane oxygenation (ECMO) patients is an aspect of a severe respiratory failure (SRF) service, which has generally low volume and high risk thus necessitating attention to particular safety measures. One of the key aspects in preventing patient safety issues and minimising risks of harm during the transportation of an ECMO patient is to develop a well-prepared multiprofessional team. This is the k Read More