Lars Desmet | PubMed Health

PubMed2006

Ventricular unloading with a miniature axial flow pump in combination with extracorporeal membrane oxygenation.

OBJECTIVE: ECMO for acute cardiorespiratory failure is an established therapeutic option. Persistent insufficient unloading of the left ventricle (LV) can compromise recovery of ventricular function. We decided to insert a miniature rotary blood pump (Impella) for decompression of the LV. In contrast to previous experience with this new device, where it was generally used for postcardiotomy heart failure or cardiogenic shock and inserted in the operating room or the catheter laboratory, this is the first report describing the potential of this technology in the intensive care unit, in a patient on ECMO and the value of echocardiography guidance. PATIENT: A 13-year-old boy with a history of congenital heart disease was admitted to the ICU with acute cardio-respiratory failure. INTERVENTIONS: On day 2 venoarterial ECMO was instituted because of worsening cardiorespiratory insufficiency refractory to conventional treatment. On day 5 a percutaneous rotary blood pump was inserted to decompress the LV. CONCLUSIONS: A percutaneous miniature rotary blood pump can be an alternative to decompress a failing LV in the setting of VA-ECMO. Echocardiography can avoid the use of fluoroscopy and the transport to a catheter laboratory to insert the rotary pump.

Adolescent↗

PubMed2004

Transfusion in pediatrics.

In reviewing the literature, the authors noted an important variation in stated and observed transfusion practice patterns among pediatric critical care practitioners, and in published guidelines on RBC transfusion. They also noted a paucity of clinical evidence with respect to RBC transfusion to critically ill children. There has been only one large randomized trial in adults, and the authors do not believe that the results from this trial should be generalized to critically ill children because of the many differences in children and their adaptive responses, and differences in disease processes. More research about anemia and RBC transfusion to critically ill children must be performed. The TRIPICU study is testing the safety of giving more or less RBC transfusion to stable critically ill children. Other studies must be done on the epidemiology and determinants of RBC transfusion in PICUs, on prevention of transfusion, and on alternatives to RBC transfusion (eg, erythropoietin).

Anemia↗