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Au moment d'être admis à exercer la médecine, je promets et je jure d'être fidèle aux lois de l'honneur et de la probité ,
, Mon premier souci sera de rétablir, de préserver ou de promouvoir la santé dans tous ses éléments, physiques et mentaux, individuels et sociaux
, Je respecterai toutes les personnes, leur autonomie et leur volonté, sans aucune discrimination selon leur état ou leurs convictions. J'interviendrai pour les protéger si elles sont affaiblies, vulnérables ou menacées dans leur intégrité ou leur dignité. Même sous la contrainte
, Je ne tromperai jamais leur confiance et n'exploiterai pas le pouvoir hérité des circonstances pour forcer les consciences
, Je ne me laisserai pas influencer par la soif du gain ou la recherche de la gloire
, Reçu(e) à l'intérieur des maisons, je respecterai les secrets des foyers et ma conduite ne servira pas à corrompre les moeurs
, Je ne prolongerai pas abusivement les agonies. Je ne provoquerai jamais la mort délibérément
, Je n'entreprendrai rien qui dépasse mes compétences. Je les entretiendrai et les perfectionnerai pour assurer au mieux les services qui me seront demandés
, J'apporterai mon aide à mes confrères ainsi qu'à leurs familles dans l'adversité
, Que les hommes et mes confrères m'accordent leur estime si je suis fidèle à mes promesses ; que je sois déshonoré(e) et méprisé(e) si j'y manque
FELLAHI Introduction et Objectif de l'étude -L'utilisation de l'ECMO dans le choc septique de l'adulte repose sur des cas cliniques et des petites séries rétrospectives. Elle est recommandée avec un niveau de preuve faible (grade 2C) dans le choc septique réfractaire en pédiatrie et néonatalogie. L'objectif de cette étude était d'analyser les patients adultes atteints de choc septique ayant bénéficié d'une ECMO veino, 2008. ,
, Matériel et méthodes -Tous les patients ayant bénéficié d'une ECMO veino-artérielle dans le cadre d'un choc septique entre 2007 et 2019 ont été inclus rétrospectivement. Les données cliniques et démographiques des patients ont été recueillis de manière exhaustive. Le SAVE score, le score SOFA et l'IGS2 ont été calculés et la survie des patients à 28 jours et à 12 mois systématiquement analysés
, Les résultats sont exprimés en médiane [extrêmes] ou moyenne ± déviation standard
, urinaires (2) et endométriale sur dispositif intra-utérin (1), Résultats & Discussion -Treize patients d'âge moyen 44±13 ans (9 femmes, 69%) ont été inclus dans l'étude. Les infections étaient pulmonaires (5), digestives (4)
, Deux patients étaient en arrêt cardiaque lors de la mise en place de l'ECMO et n'ont pas récupéré de rythme cardiaque spontané à la fin de la procédure
Huit patients (61%) ont été sevrés de l'ECMO avec succès. Sept patients (53%) étaient en vie à J28 et 5 patients (38%) étaient vivants à la sortie de l ,
, Conclusion -La survie à J28 des patients bénéficiant d'une ECMO pour choc septique semble acceptable dans cette étude, supérieure à celle prédite par le SAVE score. Les délais de sevrage de l'ECMO sont compatibles avec la récupération de la cardiomyopathie septique chez les patients adultes. La performance ventriculaire gauche chez les survivants est bonne et cohérente avec les données de la littérature
, Mots clés : ECMO veino-artérielle, ECLS, assistance circulatoire, choc septique, cardiomyopathie septique, sepsis, infection, adultes