ABSTRACT Background: Venoarterial extra corporeal membrane oxygenation (VA-ECMO) is a rescue intervention used in patients with cardiogenic shock (CS) or cardiac arrest (CA) refractory to conventional medical therapies. Objective: The aim of the present study is to describe the characteristics and summarize our 7-year experience in patients with CS or CA supported with VA-ECMO. Methods: We conducted a single-center retrospective study analyzing consecutive adult patients requiring VA-ECMO due to refractory CS or CA at ICBA, Instituto Cardiovascular between January 2014 and December 2020. Results: A total age 54 patients were included (54 ± 12 years), 36.5% presented ischemic cardiomyopathy and 23.1% significant valvular heart disease. The indications for VA-ECMO implantation were post-cardiotomy (43.4%), refractory CS (28.3%) and primary graft dysfunction (20.8%). Cardiopulmonary resuscitation before VA-ECMO occurred in 18.5% of the cases. Peripheral cannulation was performed in 81.5% of the cases, 83.3% had INTERMACS profile 1 and 87% were on intraaortic balloon pump. Duration of ventricular assistance on VA- ECMO was 5.5 days (IQR 2.8-10). Survival rate on ECMO VA was 63% (37% as a bridge to cardiac transplantation and 26% as a bridge to recovery) and survival to discharge was 42.6%. The most common complications were hemorrhage (61.1%), infections (51.9%), and thromboembolic complications (46.3%). Conclusion: In our center, VA-ECMO as a treatment for refractory CS or CA showed acceptable survival during ventricular support and on hospital discharge. It is an effective life support treatment to rescue critically ill patients when conventional therapies fail, is apparently useful and can be implemented in a country with limited resources and access to complex ventricular assist devices.

RESUMEN Introducción: La oxigenación por membrana extracorpórea venoarterial (ECMO VA) es una intervención de rescate en pacientes con shock cardiogénico (SC), y paro cardiorrespiratorio (PCR) refractarios a las terapias convencionales. Objetivo: Describir las características, y resumir nuestra experiencia inicial de 7 años de pacientes que requirieron ECMO VA por SC o PCR. Material y métodos: Se realizó un estudio de cohorte unicéntrico. Se analizaron retrospectivamente los pacientes adultos consecutivos que fueron asistidos con ECMO VA por SC o PCR refractarios entre 2014 y 2020 en el ICBA Instituto Cardiovascular. Resultados: Se incluyeron 54 pacientes, (54 ± 12 años). El 36,5% presentó miocardiopatía isquémica, y el 23,1% enfermedad valvular significativa. Las indicaciones para ECMO VA fueron: poscardiotomía (43,4%), SC refractario (28,3%), y falla primaria del injerto (20,8%). La reanimación cardiopulmonar previa a la ECMO VA se realizó en el 18,5%. La canulación fue periférica en el 81,5%, el 83,3% se asistió en INTERMACS 1, y el 87% presentaba balón de contrapulsación intraaórtico. La duración de asistencia en ECMO VA fue de 5,5 días (RIC 2,8-10). La tasa de supervivencia en ECMO VA fue del 63% (37% puente a trasplante cardíaco, y 26% recuperación), y al alta del 42,6%. Las complicaciones más frecuentes fueron: sangrado (61,1%), infección (51,9%), y complicaciones tromboembólicas (46,3%). Conclusión: La ECMO VA como tratamiento del SC o PCR refractarios en nuestro centro presentó una sobrevida aceptable al alta hospitalaria. La ECMO VA es un tratamiento efectivo cuando las terapias convencionales fallan, siendo aparentemente útil y aplicable en un país donde existe acceso limitado a los dispositivos de asistencia ventricular compleja.

RESUMO O artigo tem por objetivo mapear as relações que o rap produzido na cidade de São Paulo estabeleceu, desde a década de 1990, com o samba. Em perspectiva interdisciplinar, o mapa apresenta e discute sete pontos: 1) a importância do samba para a formação musical de MCs e DJs; 2) a presença do samba e do rap em bailes black e, posteriormente, em gravadoras que se originaram de equipes que organizavam estes bailes; 3) a função política e social da música nos momentos de lazer de bairros periféricos; 4) canções que buscaram fundir rap e samba em suas formas; 5) canções e discos que buscaram justapor rap e samba, o que tornou mais evidentes as diferenças; 6) conflitos entre o rap e o samba atravessados por questões de etnia, de ideologia, de mercado ou de gênero; 7) a noção de que o pagode e o rap construíram juntos uma identidade masculina negra periférica.

ABSTRACT The main purpose of this paper is to discuss the relationships that rap produced in the city of São Paulo established with samba since the 1990s. In the interdisciplinary perspective that one takes, the map presents and analyses seven points: 1) the importance of the samba for the musical formation of MCs and DJs; 2) the samba and the rap in black parties and later in record companies; 3) the political and social function of the music in leisure time, in the outskirts of São Paulo; 4) the forms of songs that sought to mix the rap and the samba; 5) the senses of songs and albums that sought to juxtapose the rap and the samba; 6) the conflicts between the rap and the samba caused by ethnic and racial relationships, ideological disputes, competitions in music market or gender relationships; 7) the contribution of the “pagode” and the rap to peripheral black male subjectivity construction.