[Extracorporeal respiratory assistance (ECRA): initial experiences in Spain].
The attendance respiratory extracorporeal (AREC) is an oxygenation form for membrane extracorporeal with flow tidal and veno-venous cannula described by Chevalier et al. in 1990. We present our clinical experience so much with AREC in system veno-venous flow tidal as veno-arterial. From october of 1997 until the present time we have treated three patients by means AREC, in two patients with veno-venous system and in one veno-arterial. In all the cases bomb Collin-Cardio has been used with bladder for flow tidal and membrane of oxygenation of 0.8 m2, being inserted a system of alternative clamp of the branches of the circuit. The system AREC has been used in two patients with congenial diaphragmatic hernia, right in a case and left in the other one. The gestational age was of 38 and 36 weeks with a weight of 3,200 and 2,900 grams. Both patients were remitted from other centers by failure of the conventional treatment. In both cases the indication of AREC was the sharp deterioration of the general state with failure of the conservative treatment, being the previous oxygenation index of 109 and 112. The third patient precised veno-arterial AREC for ventricular failure during the correction of the congenital heart disease, this patient was 5 month old and the weight was 5,000 grams. The duration of AREC in the cases of congenital diaphragmatic hernia was of 14 and 10 days. In a patient the diaphragmatic hernia was corrected at the 55 hours of being in AREC. In the second case the hernia had been surgical corrected in another center. The exit of AREC in both cases carries out after a discreet improvement of the lung function. Both patients died at the 24 and 48 hours of the decannulation for cerebral hemorrhage and respiratory failure. The third patient stayed stable in veno-arterial AREC during 4 days, with hemodynamic support of 130 ml/kg/min, retiring the support to present absence of cerebral activity.


CONCLUSIONS
With the derived limitations of the extreme severity of the treated cases and the current phase of beginning of the AREC team, we think that it is a useful and available technique in our country, for the handling of patient with cardiorespiratory failure while waiting for improvement of their base pathology.
Sánchez Luna
M
M
Servicio de Neonatología, Hospital Universitario Gregorio Marañón, Madrid.
Vázquez
J
J
Blanco
D
D
Greco
R
R
Arias
B
B
Cerdá
J
J
Caballero
S
S
Molina
E
E
Serrano
M L
ML
Agustín
J C
JC
Franco
M L
ML
Sánchez
R
R
Barrientos
G
G
Romero
R
R
D000367:Age Factors; D001784:Blood Gas Analysis; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012131:Respiratory Insufficiency / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors