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Martínez-Sellés D Oliveira Soares, Manuel

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First Name
Manuel
Last Name
Martínez-Sellés D Oliveira Soares
URI
https://hdl.handle.net/20.500.14352/79067
Affiliation
Universidad Complutense de Madrid
Faculty / Institute
Medicina
Department
Medicina
Area
Medicina
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Author: García Carreño, Jorge × Has files: true ×

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    Survey on Cardiogenic Shock and the Use of ECMO and Impella in Spanish Cardiac Critical Care Units
    (Journal of Vascular Diseases, 2023) García Carreño, Jorge; Martínez-Solano, Jorge; Sousa, Iago; Juárez-Fernández, Miriam; Martínez-Sellés D Oliveira Soares, Manuel
    Background: Previous studies suggest variability in the management of cardiogenic shock (CS). Methods: An anonymous survey was sent to Spanish hospitals. Results: We obtained 50 answers, mainly from cardiologists (36–72%). The annual average of ECMOs is 16.7 ± 11.3 applications in CS patients and of Impellas is 8.7 ± 8.3 applications in CS patients. Intra-aortic balloon counterpulsation is used in the majority of CS ECMOs (31–62%), and Impella is used in 7 (14%). In 36 (72%) cases, ECMO is used as a treatment for cardiac arrest. In 10 cases, ECMO removal is percutaneous (20%). In 25 (50%) cases, age is a relative contraindication; 17 have a mobile ECMO team (34%); and 23 (46%) have received ECMO patients from other centers in the last year. Pre-purged ECMO is only used in 16 (32%). ECMO implantation is carried out under ultrasound guidance in 31 (62%), only with angiography in 3 (6%) and with both in 11 (22%). The Swan–Ganz catheter is used routinely in 8 (16%), only in doubtful cases in 24 (48%), and in most cases in 8 (16%). The ECMO awake strategy is used little or not at all in 28 (56%), in selected cases in 17 (34%), and routinely in 5 (10%). Conclusion: Our study shows a huge variation in the management of patients with CS.
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    Nosocomial infections in adult patients supported by extracorporeal membrane oxygenation in a cardiac intensive care unit
    (Microorganisms, 2023) Mornese Pinna, Simone; Sousa Casasnovas, Iago; Olmedo, María; Machado, Marina; Juàrez Fernández, Miriam; Devesa Cordero, Carolina; Galar, Alicia; Álvarez Uría, Ana; Fernández Avilés, Francisco; García Carreño, Jorge; Martínez-Sellés D Oliveira Soares, Manuel; De Rosa, Francesco Giuseppe; Corcione, Silvia; Bouza Santiago, Emilio; Muñoz García, Patricia Carmen; Valerio Minero, Maricela
    The use of venoarterial (VA) extracorporeal membrane oxygenation therapy (ECMO) in patients admitted to cardiac intensive care units (CICU) has increased. Data regarding infections in this population are scarce. In this retrospective study, we analyzed the risk factors, outcome, and predictors of in-hospital mortality due to nosocomial infections in patients with ECMO admitted to a single coronary intensive care unit between July 2013 and March 2019 treated with VA-ECMO for >48 h. From 69 patients treated with VA-ECMO >48 h, (median age 58 years), 29 (42.0%) patients developed 34 episodes of infections with an infection rate of 0.92/1000 ECMO days. The most frequent were ventilator-associated pneumonia (57.6%), tracheobronchitis (9.1%), bloodstream infections (9.1%), skin and soft tissue infections (9.1%), and cytomegalovirus reactivation (9.1%). In-hospital mortality was 47.8%, but no association with nosocomial infections was found (p = 0.75). The number of days on ECMO (OR 1.14, 95% CI 1.01–1.30, p = 0.029) and noninfectious complications were higher in the infected patients (OR: 3.8 95% CI = 1.05–14.1). A higher baseline creatinine value (OR: 8.2 95% CI = 1.12–60.2) and higher blood lactate level at 4 h after ECMO initiation (OR: 2.0 95% CI = 1.23–3.29) were significant and independent risk factors for mortality. Conclusions: Nosocomial infections in medical patients treated with VA-ECMO are very frequent, mostly Gram-negative respiratory infections. Preventive measures could play an important role for these patients.