ECMO in Critical Care

Dr-Akram-Abdel-Bary-ECMO-EXPERTS-Egypt. Presentation by Professor Akram Abdel Bary, Professor of Critical Care Medicine, Cairo University

Therapeutic strategies in managing cardiac arrest

Updated resuscitation guidelines emphasize the need for minimally interrupted high quality chest compressions as a prerequisite for successful resuscitation outcome.
Resuscitation involves the integration of complex systems and the interdisciplinary coordination of multispecialty emergency and critical care providers.
The immediate period following return of spontaneous circulation (ROSC) is crucial and is dominated by the presence of two critical goals- identification of pathophysiological cause, and the assessment and initiation of time- dependent interventions, directed at preventing recurrent arrest, and improving immediate and long- term outcome.
There is no vasopressor or anti-arrhythmic agent whose use is associated with improved outcome at discharge. In-hospital resuscitation should focus on the provision of high quality chest compressions and the search for immediate treatable precipitants of the arrest in those patients who achieve ROSC.
A systematic checklist may aid in the systematic evaluation of patients following ROSC.

Management after resuscitation from cardiac arrest

Following return of spontaneous circulation, the quality of the treatment provided in the post-arrest period influences outcome.
Most patients resuscitated after a prolonged period of cardiac arrest will develop the post-cardiac arrest syndrome.
All survivors of out-of-hospital cardiac arrest should be considered for urgent coronary angiography unless the cause of cardiac arrest was clearly non-cardiac or continued treatment is considered futile.
Several interventions may impact on neurological out-come, the most significant of these is targeted temperature management.
In patients remaining comatose after resuscitation from cardiac arrest, prediction of the final outcome in the first few days may be unreliable. Prognostication should normally be delayed until at least 3 days after return to normothermia and should involve more than one than one mode (e.g. clinical examination combined with another investigation).

Post- cardiac arrest brain injury- this manifests as coma and seizures.
Post- cardiac-arrest myocardial dysfunction –this can be severe and usually recovers after 48 hours.
Systemic ischemia/reperfusion response –tissue reperfusion can cause programmed cell death (apoptosis) effecting all organ systems.
Persisting precipitating pathology-coronary artery disease is the commonest precipitating cause after OHCA

By Dr Naglaa Bazan, Critical Care Center, Cairo University

Presented by Dr Farouk Moustafa , Critical Care Center , Cairo University

Presented by Professor Hassan Khaled at the Critical Care Center Journal Club

Presentation by Dr Moataz El Hallage

Critical Care Center, Cairo University

“Adapted from Oxford Textbook of Critical Care-Oxford University Press 2016”

Human immunodeficiency virus (HIV) is increasingly a controllable disease in North America and life expectancy in patients adherent to combination antiretroviral therapy (cART) is similar to the general population.
The majority of a admissions of HIV positive patients to the ICU are for reasons unrelated to their HIV, although presentations due to opportunistic infections and malignancies must be considered in those with previously undiagnosed infection or in those patients non-adherent to cART.
The CD4 count is critical in determining the degree of immune suppression in a patient and should be checked in all critically ill HIV-infected patients to determine appropriate work-up and management of HIV- related infections/complications.
It is important to involve an infectious disease specialist familiar with HIV in the care of a critically ill HIV-infected patient, particularly if therapy requires alterations or cessation of cART or if the patient is found to be significantly immunocompromised.
Antiretroviral agents have many potential drug interactions and rare toxicities which must be evaluated throughout the ICU stay as concomitant medications are introduced.