La oxigenación por membrana extracorpórea (OMEC), también conocida como ECMO por sus siglas en inglés (ExtraCorporeal Membrane Oxygenation), es una técnica extracorpórea para proporcionar soporte cardíaco y respiratorio a pacientes cuyos pulmones y corazón están gravemente dañados y no pueden desarrollar su función normal.

La implementación de la terapia de circulación extracorpórea requiere de un equipo multidisciplinario. Nuestro equipo médico, además de haber colocado el primer paciente en ECMO con personal 100% panameño, han recibido entrenamiento en los centros de ECMO mas prestigiosos de Europa: Diplomado Europeo del Centro la Petit Salpetrier de ECMO en Paris, Estados Unidos, y certificaciones internacionales actualizadas que garanticen la calidad de atención del paciente en estos momentos tan críticos.

Se requiere una atención constante las 24 horas / 7 días a la semana durante el tratamiento con ECMO por médicos intensivistas y personal en cuidados intensivos que tengan este entrenamiento.

El tratamiento ECMO puede asegurar durante días o semanas la oxigenación de la sangre, sustituyendo completamente la función de los pulmones y el corazón. Sin embargo, debido a los altos requerimientos técnicos y de personal, su elevado costo y al riesgo de numerosas complicaciones, el tratamiento ECMO suele ser la última opción de tratamiento, es decir, el último recurso considerado cuando fallan otros tratamientos convencionales como los farmacológicos.

¿Cómo funciona?

Un cirujano cardiovascular coloca un acceso venoso para sacar del cuerpo la sangre con pobre oxígeno, una bomba impulsa la sangre (corazón artificial) hacia una membrana especial que oxigena la sangre y elimina el bióxido de carbono (Pulmón artificial) y otra cánula o acceso para regresar la sangre oxigenada a una arteria de gran calibre hacia el corazón (ECMO Veno-arterial) o a otra vena de gran calibre (ECMO Veno-venoso).

Puesto que el proceso es delicado y complejo, es necesario monitorear una gran cantidad de información. Esto permite evaluar la funcionalidad de ECMO y sus efectos en el paciente. El sistema de monitoreo incluye, entre otros aspectos:

  • Oxigenación cerebral
  • Ondas cerebrales
  • Oxigenación sanguínea
  • Presión sanguínea antes y después de pasar por el sistema
  • Temperatura de la sangre
  • Presión de bombeo
  • Cantidad de sangre que se bombea
  • Monitoreo de la función pulmonar
  • Monitoreo de la función cardiaca

¿Qué hace la oxigenación por membrana extracorpórea?

ECMO está diseñado para apoyar la función cardiaca y/o pulmonar cuando la función cardiaca y/o pulmonar del paciente es inadecuada. ECMO no cura la enfermedad del pulmón; solamente apoya al paciente para permitir que sus pulmones o corazón descansen.

¿Cuánto tiempo debe permanecer una persona en ECMO?

ECMO generalmente continua de tres a 21 días dependiendo de la severidad de la condición del paciente. La decisión de suspender la oxigenación por membrana extracorpórea la toman todos los médicos involucrados en el cuidado del paciente después de cuidadosa evaluación de la función de su pulmón y corazón.

¿Cuáles son las posibilidades de supervivencia de una persona después de oxigenación por membrana extracorpórea?

No es posible señalar específicamente las posibilidades de supervivencia, deben ser individualizadas con la consideración cuidadosa de la causa de enfermedad del pulmón o corazón, los pasos a tomar del hospital antes del apoyo de ECMO y los pasos a tomar bajo ECMO. Recuerde que ECMO sólo se ofrece a niños que tienen un potencial de supervivencia sana. Actualmente durante la Pandemia del COVID-19 en pacientes con daño pulmonar es considerado una última herramienta para que descansen los pulmones o sirve de terapia de puente para trasplante cardiaco y trasplante pulmonar.

¿Qué posibilidades hay de una vida normal después de ECMO?

Oxigenación por membrana extracorpórea se ofrece a niños que tienen una oportunidad de supervivencia sana, pero hay varios posibles problemas que pueden ocurrir a largo plazo. Estos incluyen enfermedad pulmonar crónica y problemas neurológicos.

¿El paciente necesitará atención de seguimiento?

Sí. Aunque la enfermedad del corazón o pulmón está mejor ahora, el paciente puede haber estado expuesto a bajos niveles de oxígeno significativos antes de ECMO. Esto coloca a el paciente en mayor riesgo de problemas de desarrollo.

Comprehensive services for inpatients and outpatients are provided in most medical specialties.

Internal Medicine doctors are certified general internists who specialize in the care of adult patients with various medical symptoms and problems.

  • Attention to patients with symptoms and indefinite complaints, such as shortness of breath, chest pain and new episodes of pain, to help with diagnosis and treatment recommendations.
  • Coordination of patient care provided by surgeons and other specialists in the hospital.
  • Preventive screening services for health maintenance, for example, mammograms, Pap tests, routine colon cancer screening, cholesterol screening and blood pressure screening.
  • Collaborative care of patients with chronic medical diseases, including high blood pressure, diabetes, heart disease and emphysema, throughout the various stages of their disease.
  • Comprehensive management of medical needs for hospitalized patients.
  • Preoperative evaluation of medical risks before surgery.
  • Patients are treated for general health exams, as well as for inquiries about complex medical problems.

NCC is dedicated to providing specialized care to these patients and studying resuscitation and treating patients who survive resuscitation. cardiopulmonary (CPR). A dedicated medical team helps coordinate prehospital care, the emergency department, the intensive care unit, cardiology, neurology, interventionists, cardiology and rehabilitation providers, to ensure a unique continuity of care for the patient and their families. Advanced neuroimaging and continuous electroencephalography help guide the neurocritical care of these patients.

A variety of physiological changes occur after cardiac arrest. Individual patients may experience none, some or all of these changes. Mortality is most often related to a brain injury or multiple organ failure. Aggressive neurocritical care, including the use of therapeutic hypothermia, usually begins immediately when the team receives the patient.

Neurocritical Care is a unique discipline that provides critical care to patients with a wide range of neurological disorders, including stroke, subarachnoid hemorrhage, brain trauma, coma, intracerebral hemorrhage, seizures, spinal cord trauma, epileptic state, encephalitis, myasthenia gravis, guillain- Barre syndrome and neuromuscular disease. 

A focus on recognizing altered brain and spinal cord function and immediate intervention to prevent secondary injuries improves outcomes and reduces hospitalization costs.

The teamwork of a cutting-edge doctor in neurosurgical / neurological intensive care (ICU) led by a neurointensivist.

An elite team of neuroscience nurses, respiratory technologists, EEG technologists and nursing managers provides minute-by-minute care at the ICU.

Multimodal nervous system monitoring includes electroencephalography (EEG), evoked potentials (PD), transcranial doppler (TCD), cerebral blood flow, intracranial pressure monitoring, cerebral oxygen, cerebral microdialysis and positron emission tomography (PET), diffusion by MRI / Perfusion.

Continuous monitoring of EEG (cEEG) in the ICU detects silent seizures, which occur in 20 percent of patients with traumatic brain injury in a coma and worsen intracranial pressure.

Up to 10% of strokes can occur in relatively young people (under 45 years old) and represent a challenge in terms of diagnosis and treatment. Patients generally undergo a detailed evaluation that includes images of the brain, vascular studies, cardiac evaluations and hematological evaluation using the most advanced diagnostic techniques. The Neuro & Critical Care cerebrovascular team has experience in the diagnosis and management of a variety of rare conditions that can occur in young adults, such as arterial dissection, vasculitis, cerebral vein thrombosis and moya-moya syndrome.

Endovascular therapy is changing the way that heart attacks, strokes and vascular conditions that once required invasive surgery can now be repaired by minimally invasive procedures. Because endovascular procedures are less invasive, patients spend less time in the hospital and less time to recover. Some diseases in which we offer neuroendovascular procedure are:

  • Acute Ischemic and Hemorrhagic Stroke
  • Brain aneurysm
  • Angioplasty and stenting in the carotid artery
  • Stent-assisted coil embolization (for wide neck aneurysms)
  • Cerebral angioplasty and stent placement
  • Treatment of arteriovenous malformations.
  • Spine Interventions
  • Vertebroplasty
  • Tumor embolization

Our surgical and endovascular services include:

  • Medical treatment options for acute ischemic stroke, including administration of TPA, intraarterial thrombolysis and mechanical revascularization through the use of Merci and Penumbra devices
  • Treatment options based on procedures for acute hemorrhagic stroke, including open surgical clipping, endovascular wrap using a wide range of commercially available embolic materials, endovascular liquid embolization through the use of Onyx® HD-500 and stent and balloon devices for Help in endovascular therapy.
  • Stents (flexible wire tube used to hold open vessels from within) for the treatment of intracranial atherosclerosis, carotid stenosis or cerebrovascular dissections, including Wingspan ™, Enterprise ™, Neuroform ™ and Acculink ™ stents.
  • Multimodal AVM therapy, which includes open microsurgery, stereotactic radiosurgery and endovascular embolization.

The critical trauma care unit is an interdisciplinary team of experts in the management of critically ill and injured patients. Available 24 hours a day, these intensivists offer consultation and referral services to community doctors who require support in the treatment of patients during a serious illness.

Patients who require a high level of monitoring and intervention after trauma or during a critical illness can benefit from critical care providers of trauma care. The critical care unit has immediate access to a wide range of sophisticated diagnostic and therapeutic equipment. The patient care areas have nurses with specialized training in critical care.

Sepsis is a life-threatening complication of an infection that could affect all vital signs quickly (Toxemia). Sepsis triggers inflammation throughout the body. This inflammation can trigger a cascade of changes that can damage multiple organ systems and cause them to fail.

If sepsis progresses to septic shock, blood pressure drops dramatically, this can lead to death.

Anyone can develop sepsis and early treatment, usually with antibiotics and large amounts of intravenous fluids for the recovery of blood pressure, improves the chances of survival.

A rapid diagnosis and intervention for severe sepsis or septic shock will improve the patient, it can represent an important opportunity for the recognition and care of sepsis.

In the most severe situation, the patient should be monitored in the intensive care unit, with an experienced doctor for early diagnosis and rapid aggressive treatment directed with antibiotics. The infection leads to a potentially fatal drop in blood pressure, called septic shock. This can quickly lead to the failure of several organs (lungs, kidneys and liver) and cause death.

The goal of postoperative neurocritical care is to prevent or minimize secondary neuronal damage and improve the functional recovery of the central nervous system (CNS) and the patient's quality of life.

  • Provide a gentle exit from anesthesia.
  • Optimize hemodynamic, volume and postoperative electrolytic state
  • Treat homeostatic disorders (temperature, glucose)
  • Identify and manage postoperative complications and deregulations.

After brain surgery, it will take a while for the patient to return to their usual energy level. Healing requires extra rest.

The amount of time required to recover after brain surgery is different for each person and depends on:

  • The procedure used to remove the brain tumor.
  • The location of the tumor inside the brain.
  • Areas of the brain affected by surgery.
  • The patient's age and his general state of health.

The patient will be able to see family members once the doctors and nurses have completed their evaluations and the patient is stable. This usually takes about an hour.

After surgery, the patient may need help from recovery and rehabilitation specialists. 

Patients go through surgeries to correct problems that affect their daily lives. But sometimes the procedures present some difficulties and, in some scenarios, special monitoring is necessary for patient recovery. Complex surgeries in gynecology, cardiovascular, neurosurgery, air and thoracic; for example, it will require very close monitoring.

We create a safe ring around our postoperative patient and try to help surgeons succeed with their main goals: patient safety and early recovery.