Commentary: Building bridges with extracorporeal membrane oxygenation
Notice bibliographique
Résumé
Central MessageECMO is an important bridge from ventilatory failure to normal lung function and can provide precious time for tracheal injury.See Article page 389. ECMO is an important bridge from ventilatory failure to normal lung function and can provide precious time for tracheal injury. See Article page 389. In this issue of JTCVS Techniques, Hawkins and colleagues1Hawkins R.B. Thiele E.L. Huffmyer J. Bechtel A. Yount K.W. Martin L.W. Extracorporeal membrane oxygenation for management of iatrogenic distal tracheal tear.J Thorac Cardiovasc Surg Tech. 2020; 4: 389-391Scopus (1) Google Scholar present a challenging case of iatrogenic tracheal injury after multiple intubation attempts. The patient had presented with respiratory compromise due to viral pneumonia, and the resultant loss of tidal volume due to the tracheal injury precipitated profound respiratory failure and acidosis. After transfer to the authors' institution, the patient was promptly placed on veno-venous extracorporeal membrane oxygenation (ECMO), which allowed for stabilization and normalization of acid-base status. At 12 hours after ECMO, the trachea was successfully repaired, and the patient was eventually able to transition back to normal health. This case report is not the first to describe ECMO as a bridge for surgery. It has been described in patients with trauma, lung transplantation, and tracheal injury. However, this case report is unique inasmuch as ECMO was not the only bridge. The rapid transfer to a tertiary center was probably a key—and perhaps underrecognized—step in saving this patient's life. Delays in transfer could have resulted in irreversible lung and brain damage that might not have been salvageable. The decision to delay surgical repair after the patient was placed on ECMO was also a key element in this success story. The aggressive treatment of complications, necessitating repeat surgery, is another important link in the chain. As such, although ECMO provided a bridge to surgical repair, this bridge had multiple pillars. This case demonstrates yet again that surgery is a multiteam sport, not a one-team sport. As we push the boundaries of what we can achieve in medicine, we find ourselves being operatives within a complex and interconnected system of disciplines and decisions, and building bridges becomes the best strategy for success. Extracorporeal membrane oxygenation for management of iatrogenic distal tracheal tearJTCVS TechniquesVol. 4PreviewTracheobronchial injuries during intubation are rare, with an incidence of 0.005%; thus, diagnosis requires a high index of suspicion.1 Risk factors include female sex, age older than 65 years, and emergency intubation.1,2 Temporal correlation with respiratory failure, subcutaneous emphysema, and pneumothorax/pneumomediastinum should prompt evaluation of the tracheobronchial tree. Bronchoscopy is instrumental for diagnosis and management, including placement of the endotracheal tube distal to the injury before definitive intervention. Full-Text PDF Open Access
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».