RESUMEN
Adequate and durable recovery in patients supported with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) can be challenging to predict. Extracorporeal membrane oxygenation weaning is the process by which the ECMO flows are decreased to assess if a patient is ready for decannulation. The optimal strategies for deciding who to wean and how to wean VA ECMO remain undefined. A retrospective literature review was performed to understand the evidence supporting current practices in ECMO weaning and in particular patient selection and methods. Most published work and expert opinions agree that once the underlying process has resolved, the minimum required physiologic parameters for weaning from ECMO include: hemodynamic stability and cardiac pulsatility, adequate lung function to support oxygenation and ventilation, and evidence of recovered end organ function. Echocardiography is universally used to assess cardiac function during the weaning process. Currently, there is no consensus regarding who is eligible to wean or how to wean ECMO in adults. We have reviewed the literature to summarize the evidence and expert opinions behind VA ECMO weaning, and give an example of the protocol used at our center. We believe this protocol optimizes patient selection for weaning and helps to predict successful decannulation.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Adulto , Ecocardiografía , Oxigenación por Membrana Extracorpórea/efectos adversos , Hemodinámica , Humanos , Estudios Retrospectivos , Choque CardiogénicoAsunto(s)
Cesárea/efectos adversos , Embolia de Líquido Amniótico/diagnóstico , Paro Cardíaco/etiología , Insuficiencia Cardíaca/diagnóstico , Adulto , Reanimación Cardiopulmonar , Diagnóstico Diferencial , Ecocardiografía Doppler en Color , Ecocardiografía Transesofágica , Femenino , Paro Cardíaco/terapia , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/terapia , Humanos , Histerectomía , Infarto del Miocardio/diagnóstico , Placenta Previa/cirugía , Embarazo , Complicaciones Cardiovasculares del Embarazo/etiología , Embolia Pulmonar/diagnósticoRESUMEN
INTRODUCTION: The intensive care unit (ICU) is a dynamic and complex learning environment. The wide range in trainee's experience, specialty training, fluctuations in patient acuity and volume, limitations in trainee duty hours, and additional responsibilities of the faculty contribute to the challenge in providing a consistent experience with traditional educational strategies. The "flipped classroom" is an educational model with the potential to improve the learning environment. In this paradigm, students gain exposure to new material outside class and then use class time to assimilate the knowledge through problem-solving exercises or discussion. The rationale and pedagogical foundations for the flipped classroom are reviewed, practical considerations are discussed, and an example of successful implementation is provided. METHODS: An education curriculum was devised and evaluated prospectively for teaching point-of-care echocardiography to residents rotating in the surgical ICU. RESULTS: Preintervention and postintervention scores of knowledge, confidence, perceived usefulness, and likelihood of use the skills improved for each module. The quality of the experience was rated highly for each of the sessions. CONCLUSION: The flipped classroom education curriculum has many advantages. This pilot study was well received, and learners showed improvement in all areas evaluated, across several demographic subgroups and self-identified learning styles.