RESUMO
There has been a progressive increase in the use of mechanical circulatory support in our country in the last years, mainly in the short-term: as a bridge to cardiac transplant or recovery, which has allowed to rescue patients from a population that concentrates high rates of complications and mortality. This motivated that the Ministry of Health convened a series of experts in the area of heart failure, transplantation and mechanical circulatory support, representatives of different public and private health centers in Chile, with the objective of developing recommendations on the use of short-term mechanical assistance devices, which would serve as a reference for the proper management of these patients. This clinical experts consensus document contains topics related to: definitions and general concepts; indications; contraindications; specific aspects of starting, follow-up and weaning of the devices; process of transfer of patients in circulatory assistance from one center to another and finally criteria of organization, means and competences to be fulfilled by the centers that offer this therapeutic option.
Assuntos
Circulação Extracorpórea/métodos , Coração Auxiliar/normas , Chile , Circulação Extracorpórea/normas , Guias como Assunto , HumanosRESUMO
There has been a progressive increase in the use of mechanical circulatory support in our country in the last years, mainly in the short-term: as a bridge to cardiac transplant or recovery, which has allowed to rescue patients from a population that concentrates high rates of complications and mortality. This motivated that the Ministry of Health convened a series of experts in the area of heart failure, transplantation and mechanical circulatory support, representatives of different public and private health centers in Chile, with the objective of developing recommendations on the use of short-term mechanical assistance devices, which would serve as a reference for the proper management of these patients. This clinical experts consensus document contains topics related to: definitions and general concepts; indications; contraindications; specific aspects of starting, follow-up and weaning of the devices; process of transfer of patients in circulatory assistance from one center to another and finally criteria of organization, means and competences to be fulfilled by the centers that offer this therapeutic option.
Assuntos
Humanos , Coração Auxiliar/normas , Circulação Extracorpórea/métodos , Chile , Guias como Assunto , Circulação Extracorpórea/normasRESUMO
OBJECTIVE: to develop and validate a nursing care protocol for patients with a ventricular assist device (VAD). METHOD: descriptive study, with a quantitative approach, for an instrument's methodological validation. Three stages were conducted: development of the instrument; protocol content validation according to the Delphi technique, and agreement among experts and the scientific literature. RESULTS: based on the content validation, a care protocol for patients with a VAD was created and assessed by Spanish experts. Of the 15 items evaluated by means of the content validity index (CVI), 10 presented solid evidence of validation, with Kappa ranging between 0.87 and 1. CONCLUSION: the method enabled the validation of interventions that will contribute to qualified and standardized care for patients with a VAD.
Assuntos
Guias como Assunto , Coração Auxiliar/normas , Cuidados de Enfermagem/métodos , Padrões de Referência , Adulto , Consenso , Técnica Delphi , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha , Inquéritos e QuestionáriosRESUMO
ABSTRACT Objective: to develop and validate a nursing care protocol for patients with a ventricular assist device (VAD). Method: descriptive study, with a quantitative approach, for an instrument's methodological validation. Three stages were conducted: development of the instrument; protocol content validation according to the Delphi technique, and agreement among experts and the scientific literature. Results: based on the content validation, a care protocol for patients with a VAD was created and assessed by Spanish experts. Of the 15 items evaluated by means of the content validity index (CVI), 10 presented solid evidence of validation, with Kappa ranging between 0.87 and 1. Conclusion: the method enabled the validation of interventions that will contribute to qualified and standardized care for patients with a VAD.
RESUMEN Objetivo: elaborar y validar un protocolo de atención de enfermería a pacientes con dispositivo de asistencia ventricular (DAV). Método: estudio descriptivo, con abordaje cuantitativo, de validación metodológica de instrumento. Se siguieron tres etapas: elaboración del instrumento; validación del contenido del protocolo según técnica de Delphi y concordancia entre expertos y la literatura científica. Resultados: en base a la validación del contenido, se elaboró un protocolo referido a la atención de pacientes en uso de DAV, evaluado por expertos/jueces españoles. De los 15 ítems evaluados, mediante el índice de Validez de Contenido (IVC), 10 de ellos presentaron fuerte evidencia de validación con Kappa, variando entre 0,87 y 1. Conclusión: el método permitió validar intervenciones que contribuirán a una atención calificada y uniforme a pacientes en uso de DAV.
RESUMO Objetivo: elaborar e validar um protocolo de cuidados de enfermagem a pacientes com dispositivo de assistência ventricular (DAV). Método: estudo descritivo, com abordagem quantitativa de validação metodológica de instrumento. Seguiram-se três etapas: elaboração do instrumento; validação do conteúdo do protocolo segundo a técnica de Delphi e concordância entre peritos e a literatura científica. Resultados: com base na validação do conteúdo, elaborou-se um protocolo referente aos cuidados a paciente em uso de DAV avaliado por peritos/juízes espanhóis. Dos 15 itens avaliados, por meio do Índice de Validade de Conteúdo (IVC), 10 deles apresentaram forte evidência de validação com Kappa que variaram de 0,87 a 1. Conclusão: o método permitiu validar intervenções que contribuirão para um cuidado qualificado e uniformizado a pacientes em uso de DAV.
Assuntos
Humanos , Masculino , Feminino , Adulto , Padrões de Referência , Coração Auxiliar/normas , Guias de Prática Clínica como Assunto , Cuidados de Enfermagem/métodos , Espanha , Inquéritos e Questionários , Técnica Delphi , Consenso , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The objective of this paper is to present the results from Spiral Pump clinical trial after design modifications performed at its previous project. This pump applies axial end centrifugal hydraulic effects for blood pumping during cardiopulmonary bypass for patients under cardiac surgery. METHODS: This study was performed in 52 patients (51% males), between 20 to 80 (67±14.4) years old weighing 53 to 102 (71.7±12.6) kg, mostly under myocardial revascularization surgery (34.6%) and valvular surgery (32.8%). Besides the routine evaluation of the data observed in these cases, we monitored pump rotational speed, blood flow, cardiopulmonary bypass duration, urine free hemoglobin for blood cell trauma analysis (+ to 4+), lactate desidrogenase (UI/L), fibrinogen level (mg/dL) and platelet count (nº/mm3). RESULTS: Besides maintaining appropriate blood pressure and metabolic parameters it was also observed that the Free Hemoglobin levels remained normal, with a slight increase after 90 minutes of cardiopulmonary bypass. The Lactate Dehydrogenase showed an increase, with medians varying between 550-770 IU/L, whereas the decrease in Fibrinogen showed medians of 130-100 mg/dl. The number of platelets showed a slight decrease with the medians ranging from 240,000 to 200,000/mm3. No difficulty was observed during perfusion terminations, nor were there any immediate deaths, and all patients except one, were discharged in good condition. CONCLUSION: The Spiral Pump, as blood propeller during cardiopulmonary bypass, demonstrated to be reliable and safe, comprising in a good option as original and national product for this kind of application.
Assuntos
Procedimentos Cirúrgicos Cardíacos/instrumentação , Ponte Cardiopulmonar/instrumentação , Coração Auxiliar/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/métodos , Desenho de Equipamento/normas , Segurança de Equipamentos , Feminino , Fibrinogênio/análise , Humanos , L-Lactato Desidrogenase/sangue , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Modelos Cardiovasculares , Contagem de Plaquetas , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Objective: The objective of this paper is to present the results from Spiral Pump clinical trial after design modifications performed at its previous project. This pump applies axial end centrifugal hydraulic effects for blood pumping during cardiopulmonary bypass for patients under cardiac surgery. Methods: This study was performed in 52 patients (51% males), between 20 to 80 (67±14.4) years old weighing 53 to 102 (71.7±12.6) kg, mostly under myocardial revascularization surgery (34.6%) and valvular surgery (32.8%). Besides the routine evaluation of the data observed in these cases, we monitored pump rotational speed, blood flow, cardiopulmonary bypass duration, urine free hemoglobin for blood cell trauma analysis (+ to 4+), lactate desidrogenase (UI/L), fibrinogen level (mg/dL) and platelet count (nº/mm3). Results: Besides maintaining appropriate blood pressure and metabolic parameters it was also observed that the Free Hemoglobin levels remained normal, with a slight increase after 90 minutes of cardiopulmonary bypass. The Lactate Dehydrogenase showed an increase, with medians varying between 550-770 IU/L, whereas the decrease in Fibrinogen showed medians of 130-100 mg/dl. The number of platelets showed a slight decrease with the medians ranging from 240,000 to 200,000/mm3. No difficulty was observed during perfusion terminations, nor were there any immediate deaths, and all patients except one, were discharged in good condition. CONCLUSION: The Spiral Pump, as blood propeller during cardiopulmonary bypass, demonstrated to be reliable and safe, comprising in a good option as original and national product for this kind of application. .
Objetivos: Apresentar resultados da aplicação da bomba espiral que emprega efeitos hidráulicos centrífugo e axial de bombeamento como elemento propulsor do circuito de circulação extracorpórea em pacientes submetidos a cirurgias cardíacas após modificações introduzidas no design do projeto original. Métodos: O estudo foi realizado em 52 pacientes (51% masculinos), com idade entre 20 a 80 (67±14,4) anos, peso 53 a 102 (71,7±12,6) kg, submetidos na maioria a cirurgia de revascularização miocárdica (34,6%) e Orovalvar (32,8%). Além das avaliações rotineiras, foram registrados rotação, tempo de CEC e para análise do impacto traumático à crase sanguínea, hemoglobina livre na urina (+ a 4+), desidrogenase láctica, fibrinogênio (mg/dL) e contagem de plaquetas (nº/mm3). Resultados: Observou-se a manutenção de parâmetros pressóricos e metabólicos adequados. Quanto aos marcadores de danos à crase sanguínea, as alterações estiveram proporcionais ao tempo maior de circulação extracorpórea. Os níveis de Hemoglobina Livre permaneceram com valores normais, com ligeiro aumento a partir dos 90 minutos de circulação extracorpórea. A Desidrogenase Láctica mostrou aumento, variando as medianas entre 550 a 770 UI/L enquanto o Fibrinogênio mostrou queda das medianas de 130 a 100 mg/dl. O número de plaquetas mostrou ligeira queda das medianas variando entre 240.000 a 200.000/mm3. Não ocorreram dificuldades de saída de perfusão, não se observou óbito imediato e todos os pacientes, exceto 1, obtiveram alta hospitalar. Conclusão: A bomba espiral aplicada como bomba propulsora de sangue durante cirurgia cardíaca se mostrou confiável e segura, não causou impacto traumático ...
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Procedimentos Cirúrgicos Cardíacos/instrumentação , Ponte Cardiopulmonar/instrumentação , Coração Auxiliar/normas , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/métodos , Desenho de Equipamento/normas , Segurança de Equipamentos , Fibrinogênio/análise , L-Lactato Desidrogenase/sangue , Ilustração Médica , Modelos Cardiovasculares , Contagem de Plaquetas , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
Cardiogenic shock after myocardial infarction has a high mortality even if early revascularization is achieved. Biventricular assist devices have not been used in Chile in this critical setting. We report a case of a 55-year-old diabetic man who suffered an acute chest pain and ventricular fibrillation. Prompt outside hospital defibrillation/reanimation restored pulse and allowed emergency room transfer on mechanical ventilation. Electrocardiogram showed an anterior myocardial infarction and early revascularization was achieved by anterior descending artery angioplasty. However, severe cardiogenic shock continued in spite of inotropic and intra aortic balloon pump support. Levitronix Centrimag biventricular mechanical circulatory support was inserted during reanimation for recurrent ventricular fibrillation and the patient listed for urgent cardiac transplantation upon stabilization. Heart transplantation was performed successfully 28 days later and the patient was discharged after a 21-day recovery period. Twelve months after transplant the patient is in NYHA functional class I with normal biventricular function. Levitronix Centrimag biventricular mechanical circulatory support could be used successfully as a bridge-to-transplant for myocardial infarction cardiogenic shock.
Assuntos
Transplante de Coração , Coração Auxiliar/normas , Infarto do Miocárdio/complicações , Choque Cardiogênico/reabilitação , Choque Cardiogênico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Cardiogenic shock after myocardial infarction has a high mortality even if early revascularization is achieved. Biventricular assist devices have not been used in Chile in this critical setting. We report a case of a 55 year-old diabetic man who suffered an acute chest pain and ventricular fibrillation. Prompt outside hospital defibrillation/ reanimation restored pulse and allowed emergency room transfer on mechanical ventilation. Electrocardiogram showed an anterior myocardial infarction and early revascularization was achieved by anterior descending artery angioplasty. However, severe cardiogenic shock continued in spite of inotropic and intra aortic balloon pump support. Levitronix Centrimag® biventricular mechanical circulatory support was inserted during reanimation for recurrent ventricular fibrillation and the patient listed for urgent cardiac transplantation upon stabilization. Heart transplantation was performed successfully 28 days later and the patient was discharged after a 21-day recovery period. Twelve months after transplant the patient is in NYHA functional class I with normal biventricular function. Levitronix Centrimag® biventricular mechanical circulatory support could be used successfully as a bridge-to-transplant for myocardial infarction cardiogenic shock.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Coração , Coração Auxiliar/normas , Infarto do Miocárdio/complicações , Choque Cardiogênico/reabilitação , Choque Cardiogênico/cirurgia , Fatores de TempoRESUMO
INTRODUCTION: This paper addresses an original project that encompasses the conception, development and clinical application of a helical bypass pump called the Spiral Pump, that uses the association of centrifugal and axial propulsion forces based de the Archimedes principle. This project has obtained a Brazilian Patent and an International Preliminary Report, defining it as an invention. METHODS: The aim of this work was to evaluate the hemodynamic capacity and the impact of its application on blood cells by means of experimental in vitro tests, including hydrodynamic efficiency, effect on hemolysis and flow visualization. Moreover, in vivo experimental tests were carried out on lambs that were submitted to cardiopulmonary bypass for six hours and in 43 patients submitted to heart bypass surgery using the Spiral Pump. RESULTS: When the rotor-plastic casing gap was 1.5mm, the flow generated was nearly 9 L/min, the pressure was greater than 400 mmHg at 1500 rpm, and the normalized hemolytic indexes were not greater than 0.0375 g/100L in high-flow and pressure conditions. Additionally, by the flow visualization techniques, stagnation was not seen inside the pump nor was turbulence identified at the entrance or exit of the pump, or at the ends of the spindles. In the in vivo tests using cardiopulmonary bypasses for 6 hours in lambs, the pump maintained adequate pressure rates and the free hemoglobin levels ranged between 16.36 mg% and 44.90 mg%. Evaluating the results of the 43 patients who used this pump in heart bypass operations we observed that the free hemoglobin ranged from 9.34 mg% before to 44.16 mg% after surgery, the serum fibrinogen was from 236.65 mg% to 547.26mg%, platelet blood count from 152,465 to 98,139 and the lactic dehydrogenase from 238.12mg% to 547.26mg%. The Activated Coagulation Time was close to 800 seconds during the bypass. CONCLUSION: The Spiral Pump was very effective in generating adequate flow and pressure and caused no excessive harm to the blood cells.
Assuntos
Circulação Extracorpórea/instrumentação , Cardiopatias/cirurgia , Coração Auxiliar/normas , Hemólise , Análise de Variância , Animais , Materiais Biocompatíveis , Velocidade do Fluxo Sanguíneo , Brasil , Desenho de Equipamento , Segurança de Equipamentos , Coração Artificial , Humanos , Modelos Cardiovasculares , Patentes como Assunto , OvinosRESUMO
Despite advances in medical treatment, the prognosis of advanced heart failure remains poor. The number of hospitalizations for heart failure exacerbations continues to increase and most patients will ultimately die of complications related to heart failure. Implantable left ventricular assist devices (LVAD) are currently in use throughout the world with increasing frequency. This paper is a comprehensive review about mechanical support, focusing on a general description of the different LVAD, complications and mortality.
Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar/normas , Insuficiência Cardíaca/mortalidade , Transplante de Coração , Coração Auxiliar/efeitos adversos , Coração Auxiliar/economia , Humanos , Seleção de Pacientes , Choque Cardiogênico/mortalidade , Choque Cardiogênico/cirurgia , Análise de Sobrevida , Fatores de Tempo , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/cirurgiaRESUMO
Despite advances in medical treatment, the prognosis of advanced heart failure remains poor. The number of hospitalizations for heart failure exacerbations continues to increase and most patients will ultimately die of complications related to heart failure. Implantable left ventricular assist devices (LVAD) are currently in use throughout the world with increasing frequency. This paper is a comprehensive review about mechanical support, focusing on a general description of the differents LVAD, complications and mortality.
Assuntos
Humanos , Insuficiência Cardíaca/cirurgia , Coração Auxiliar/normas , Insuficiência Cardíaca/mortalidade , Transplante de Coração , Coração Auxiliar/efeitos adversos , Coração Auxiliar/economia , Seleção de Pacientes , Choque Cardiogênico/mortalidade , Choque Cardiogênico/cirurgia , Análise de Sobrevida , Fatores de Tempo , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/cirurgiaRESUMO
The spiral pump (SP) uses centrifugal and axial pumping principles simultaneously, through a conical shaped impeller with threads in its surface. Flow visualization studies were performed in critical areas of the SP. A closed circuit loop was filled with glycerin-water solution (40%). Amberlite particles (80 mesh) were illuminated by a planar helium-neon laser light (7 mW). The particle velocities were recorded with Kodak (TMAX-400) black and white film, and the flow behavior was studied with a micro video camera and color video printer. The flow visualization studies showed no turbulence or stagnant areas in the inlet and outlet ports of the SP. When using the impeller with one lead, at the top of the threads some recirculation appeared when the total pressure head increased. Two new impellers were made. One of them had the same conical shape with a thread having 2 leads. The second had a thread with 2 leads, but it also had a bigger cone angle. These modifications improved the pump hydrodynamic performance, decreasing the recirculation in pumping conditions that require pressures over 200 mm Hg.
Assuntos
Coração Auxiliar/normas , Centrifugação , Glicerol/química , Hélio , Fluxometria por Laser-Doppler , Neônio , Tamanho da Partícula , Controle de Qualidade , Resinas Sintéticas/metabolismo , Gravação em Vídeo , Água/químicaAssuntos
Humanos , Biópsia , Coração Auxiliar/normas , Rejeição de Enxerto/classificação , Seleção de Pacientes , Complicações Pós-Operatórias , Retratamento , Doadores de Tecidos/legislação & jurisprudência , Transplante de Coração/normas , Algoritmos , Argentina , Biópsia/efeitos adversos , Biópsia/instrumentação , Morte Encefálica/diagnóstico , Morte Encefálica/legislação & jurisprudência , Doença de Chagas/cirurgia , Coração Auxiliar/classificação , Doença das Coronárias , Rejeição de Enxerto/diagnóstico , Terapia de Imunossupressão/métodos , Insuficiência Cardíaca/cirurgia , Insuficiência Cardíaca/mortalidade , Balão Intra-Aórtico , Revascularização Miocárdica , Miocárdio , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios , Fatores de Risco , Transplante de Coração-Pulmão/estatística & dados numéricos , Transplante de Pulmão/estatística & dados numéricos , Resultado do TratamentoAssuntos
Humanos , Transplante de Coração/normas , Seleção de Pacientes , Doadores de Tecidos/legislação & jurisprudência , Complicações Pós-Operatórias , Rejeição de Enxerto/classificação , Biópsia/métodos , Mortalidade , Retratamento , Coração Auxiliar/normas , Argentina , Insuficiência Cardíaca/cirurgia , Insuficiência Cardíaca/mortalidade , Revascularização Miocárdica , Morte Encefálica/diagnóstico , Morte Encefálica/legislação & jurisprudência , Algoritmos , Terapia de Imunossupressão/métodos , Doença das Coronárias , Rejeição de Enxerto/diagnóstico , Biópsia/efeitos adversos , Biópsia/instrumentação , Miocárdio , Transplante de Coração-Pulmão/estatística & dados numéricos , Transplante de Pulmão/estatística & dados numéricos , Fatores de Risco , Doença de Chagas/cirurgia , Balão Intra-Aórtico , Coração Auxiliar/classificação , Resultado do Tratamento , Guias de Prática Clínica como Assunto , Cuidados Pré-OperatóriosRESUMO
Two well-known centrifugal and axial pumping principles are used simultaneously in a new blood pump design. Inside the pump housing is a spiral impeller, a conically shaped structure with threads on the surface. The worm gears provide an axial motion of the blood column through the threads of the central cone. The rotational motion of the conical shape generates the centrifugal pumping effect and improves the efficiency of the pump without increasing hemolysis. The hydrodynamic performance of the pump was examined with a 40% glycerin-water solution at several rotation speeds. The gap between the housing and the top of the thread is a very important factor: when the gap increases, the hydrodynamic performance decreases. To determine the optimum gap, several in vitro hemolysis tests were performed with different gaps using bovine blood in a closed circuit loop under two conditions. The first simulated condition was a left ventricular assist device (LVAD) with a flow rate of 5 L/min against a pressure head of 100 mm Hg, and the second was a cardiopulmonary bypass (CPB) simulation with a flow rate of 5 L/min against 350 mm Hg of pressure. The best hemolysis results were seen at a gap of 1.5 mm with the normalized index of hemolysis (NIH) of 0.0063 +/- 0.0020 g/100 L and 0.0251 +/- 0.0124 g/100 L (mean +/- SD; n = 4) for LVAD and CPB conditions, respectively.