{"id":554,"date":"2017-06-12T15:31:45","date_gmt":"2017-06-12T12:31:45","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdtoks\/2021\/09\/17\/ekstrakorporal-membran-oksijenasyonu-ecmo-ve-toksikoloji-deki-kullanimi\/"},"modified":"2021-11-10T22:35:24","modified_gmt":"2021-11-10T19:35:24","slug":"ekstrakorporal-membran-oksijenasyonu-ecmo-ve-toksikoloji-deki-kullanimi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/toksikoloji\/2017\/06\/12\/ekstrakorporal-membran-oksijenasyonu-ecmo-ve-toksikoloji-deki-kullanimi\/","title":{"rendered":"EKSTRAKORPORAL MEMBRAN OKS\u0130JENASYONU (ECMO) VE TOKS\u0130KOLOJ\u0130\u2019DEK\u0130 KULLANIMI"},"content":{"rendered":"

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\u0130LK BA\u015eARILI ECLS HASTASI-1971<\/strong><\/span><\/span><\/h2>\n

\"\"<\/h2>\n

\u015eekil 1. Ekstrakorporal Ya\u015fam Deste\u011fi (2)<\/span><\/span><\/h2>\n

ECMO Uygulama Y\u00f6ntemleri<\/strong><\/span><\/span><\/h2>\n

Veno-Arteryel ECMO (V-A ECMO) ve Veno-Ven\u00f6z ECMO(V-V ECMO)<\/strong><\/span><\/span><\/h3>\n

VA-ECMO\u2019da ven\u00f6z sistemden al\u0131nan kan, arteryel sistem arac\u0131l\u0131\u011f\u0131yla geri verilir. B\u00f6ylelikle hastaya solunum ve hemodinamik destek sa\u011flan\u0131rken bu s\u0131ras\u0131nda, kan hem kalbi hem de akci\u011ferleri bypass eder. VV-ECMO da ise pulmoner sistemi desteklemek amac\u0131yla kullan\u0131l\u0131r. Hastan\u0131n hemodinamisi stabil olmal\u0131d\u0131r (3).<\/span><\/p>\n

\"\"<\/p>\n

\u015eekil 2. VA-ECMO ve VV-ECMO (4)<\/span><\/span><\/h2>\n

GENEL END\u0130KASYONLAR:<\/u><\/strong><\/span><\/span><\/h2>\n

Ekstarkorporal Ya\u015fam Deste\u011fi Organizasyonuna (ELSO) g\u00f6re ECMO en ciddi\u00a0 hasta grubu i\u00e7in kullan\u0131lmal\u0131d\u0131r (5).<\/span><\/span><\/p>\n

Optimal konvansiyonel tedavilere ra\u011fmen mortalite riski %80\u2019lere kadar \u00e7\u0131kabilmektedir (ARDS i\u00e7in \u00f6l\u00fcm riski % 80’i a\u015fan hastalarda PaO2<\/sub> \/FiO2<\/sub><80 ve FiO2<\/sub>> 0,9 ve Murray skoru 3-4)<\/span><\/span><\/p>\n

Akut \u015fiddetli kalp veya akci\u011fer yetersizli\u011fi olan hasta grubuna endikedir.<\/span><\/span><\/p>\n

ECMO mortalitesinin %50 civar\u0131nda oldu\u011fu g\u00f6z \u00f6n\u00fcnde bulundurularak hastal\u0131\u011f\u0131n \u015fiddeti, hastan\u0131n ya\u015f grubu ve organ yetersizli\u011finin durumu dikkatlice de\u011ferlendirilmelidir (5).<\/span><\/span><\/p>\n

 <\/p>\n

KONTRAEND\u0130KASYON:<\/strong><\/u><\/span><\/span><\/h3>\n

1) Hasta iyile\u015fti\u011finde normal ya\u015famla ba\u011fda\u015fmayan ko\u015fullar;<\/span><\/span><\/p>\n

2) Ya\u015fam kalitesini etkileyen \u00f6nceden var olan ko\u015fullar (MSS durumu, son d\u00f6nem malignite, antikoag\u00fclasyon ile sistemik kanama riski);<\/span><\/span><\/p>\n

3)Ya\u015fam beklentisi olmayan hasta grubu: \u00e7ok hasta, konvansiyonel tedavide \u00e7ok uzun s\u00fcredir tedavi g\u00f6ren ya da \u00f6l\u00fcmc\u00fcl bir tan\u0131 alan hastalar (5).<\/span><\/span><\/p>\n

 <\/p>\n

TOKS\u0130KOLOJ\u0130\u2019de ECMO<\/u><\/strong><\/span><\/span><\/h2>\n

ECMO\u2019nun toksikolojideki kullan\u0131m alan\u0131n\u0131 de\u011ferlendirmek amac\u0131yla literat\u00fcr\u00fc tarad\u0131\u011f\u0131m\u0131zda zehirlenme sonucu refrakter \u015foklu veya ARDS\u2019si olan hasta gruplar\u0131n\u0131 i\u00e7eren randomize yap\u0131lm\u0131\u015f bir \u00e7al\u0131\u015fma hen\u00fcz mevcut de\u011fil. Yani elimizdeki en iyi kan\u0131tlar; g\u00f6zlemsel kohortlar, olgu serileri ve olgu sunumlar\u0131. Ne yaz\u0131k ki bu raporlar\u0131n \u00e7o\u011funda yay\u0131n \u00f6nyarg\u0131lar\u0131 g\u00f6zlenmektedir. Vaka raporlar\u0131na bak\u0131ld\u0131\u011f\u0131nda neredeyse sadece ‘mutlu son’ oldu\u011funda yay\u0131nland\u0131klar\u0131n\u0131 g\u00f6rmekteyiz. Bununla beraber literat\u00fcrdeki \u00f6rnekler incelendi\u011finde;<\/span><\/span><\/p>\n

Romain M. ve arkada\u015flar\u0131n\u0131n \u015fiddetli zehirlenme olgular\u0131nda ECMO kullan\u0131m\u0131 ve geleneksel y\u00f6ntemlerin kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131 retrospektif kohort \u00e7al\u0131\u015fmas\u0131nda; 62 adet olgu \u00fczerinde hareket edilerek olgular ECLS ile tedavi edilenler ve geleneksel y\u00f6ntemler ile tedavi edilenler olarak ikiye ayr\u0131lm\u0131\u015f. ECLS ile tedavi edilen 14 ki\u015filik hasta grubunda %86\u2019l\u0131k bir oran ile sa\u011fkal\u0131m elde edilirken geleneksel y\u00f6ntemler ile tedavi edilen 48 ki\u015filik hasta grubunda %48\u2019lik oran ile sa\u011fkal\u0131m elde edilmi\u015f. \u00c7al\u0131\u015fman\u0131n istatistiksel olarak anlaml\u0131 \u00e7\u0131kt\u0131\u011f\u0131n\u0131 da s\u00f6ylemek gerek (p=0.048). Mevcut sonu\u00e7lar \u0131\u015f\u0131\u011f\u0131nda \u00e7al\u0131\u015fmay\u0131 ger\u00e7ekle\u015ftiren ekibin \u00f6nerisi ECLS\u2019nin \u015fiddetli zehirlenme vakalar\u0131 \u00fczerinde kullan\u0131labilece\u011fi y\u00f6n\u00fcnde (6).<\/span><\/span><\/p>\n

Yine ba\u015fka bir \u00a0rekrospektif kohort \u00e7al\u0131\u015fmas\u0131nda Daubin C. ve arkada\u015flar\u0131, kardiyotoksik ila\u00e7 kullan\u0131m\u0131 sonras\u0131nda refrakter \u015fok ya da kardiyak arrest geli\u015fen, geleneksel tedavilere yan\u0131t vermeyen 17 vakal\u0131k VA-ECMO uygulanan olguyu incelediklerinde kardiyak arrest ge\u00e7iren 7 hastan\u0131n bulundu\u011fu gruptaki 5 hastada sa\u011f kal\u0131m elde edilirken, refrakter \u015fok grubundaki 10 hastadan ise 8\u2019inde sa\u011fkal\u0131m elde edilmi\u015ftir. Toplamda 15 adet hasta ECLS tedavisinin weaning a\u015famas\u0131n\u0131 g\u00f6rebilmi\u015f. 13 hasta ise hastaneden n\u00f6rolojik sekel olmadan tabucu olabilmi\u015f (7).<\/span><\/span><\/p>\n

Wang GS. ve arkada\u015flar\u0131n\u0131n retrospektif olarak \u2018American College of Medical Toxicology<\/a>\u2018nin veri taban\u0131ndan Ocak 2010-Aral\u0131k 2013 y\u0131llar\u0131 aras\u0131nda tibbi toksikologlar taraf\u0131ndan bildirilen vaka \u00f6rneklerini tarad\u0131klar\u0131 kohort \u00e7al\u0131\u015fmalar\u0131nda 10 adet zehirlenme olgusundaki ECMO kullan\u0131m\u0131n\u0131 incelemi\u015fler. Hasta gruplar\u0131 incelendi\u011finde 4\u2019\u00fc pediatrik ya\u015f (<12) grubunda, 2\u2019si adolesan ya\u015f (12-18) grubunda ve 4 tanesi ise yeti\u015fkin ya\u015f (>18) grubunda oldu\u011fu g\u00f6r\u00fcl\u00fcyor. Hastalar\u0131n zehirlendikleri maddere bak\u0131ld\u0131\u011f\u0131nda ise CO maruziyeti, methanol, antihistaminik, antipsikotik, kardiyovask\u00fcler ila\u00e7lar, antidiyabetikler, analjezik ajanlar, sedatif\/hipnotik ila\u00e7lar\u0131n oldu\u011fu g\u00f6r\u00fcl\u00fcyor. Hastalar\u0131n \u00e7o\u011funda \u00e7oklu organ disfonksiyonu ya da hemodinamik dengesizlik mevcutmu\u015f. Olgular\u0131n 4\u2018\u00fcnde ECMO uygulamas\u0131 esnas\u0131nda CPR gereksinimi olmu\u015f. Sonu\u00e7 olarak hastalar\u0131n %80\u2018ninde sa\u011fkal\u0131m g\u00f6zlenmi\u015f (8)<\/span><\/span><\/p>\n

Literat\u00fcrdeki vaka raporlar\u0131na ve vaka serilerine k\u0131saca bakacak olursak, ECMO ve toksik madde kullan\u0131m\u0131yla alakal\u0131 yap\u0131lan yay\u0131nlar\u0131n daha \u00e7ok bu \u015fekilde oldu\u011funu g\u00f6rmekteyiz.<\/span><\/span><\/h2>\n

Yap\u0131lan bildirimlerden birka\u00e7 \u00f6rnek verirsek vaka \u00e7e\u015fitlili\u011fini g\u00f6rme a\u00e7\u0131s\u0131ndan faydal\u0131 olaca\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnmekteyim.<\/span><\/span><\/p>\n

C. William Heise ve arkada\u015flar\u0131n\u0131n buprapion a\u015f\u0131r\u0131 al\u0131m\u0131na sekonder geli\u015fen kardiyojenik \u015fok ve sonras\u0131nda kardiyak arrest g\u00f6zlenen 2 adet hastan\u0131n bildirildi\u011fi vaka serisinde, hastalar VA- ECMO ile ba\u015far\u0131l\u0131 bir \u015fekilde tedavi edilmi\u015fler (9).<\/span><\/span><\/p>\n

American Journal of Emergency Medicine\u2019da yay\u0131nlanan ba\u015fka bir vaka raporunda ise 10 gr metaprolol al\u0131m\u0131 sonras\u0131nda kardiyak arrest g\u00f6zlenen 47 ya\u015f\u0131ndaki erkek hastada ba\u015far\u0131l\u0131 resusitasyon sonras\u0131nda, vol\u00fcm replasman\u0131 ve vazopressor tedaviye ra\u011fmen hemodinamik unstabilitenin d\u00fczeltilememesi \u00fczerine VA- ECMO\u2019yla beraber y\u00fcksek doz insulin ve lipid em\u00fclsiyonu tedavisi uygulanm\u0131\u015f. Hasta 3 g\u00fcn ECMO\u2019ya ba\u011fl\u0131 kald\u0131ktan ve 10 g\u00fcnl\u00fck takip ve tedavisinden sonra sekelsiz bir \u015fekilde hastaneden taburcu edilmi\u015f (10).<\/span><\/span><\/p>\n

Hassanian ve arkada\u015flar\u0131n\u0131n vaka raporunda ise aliminyum fosfid al\u0131m\u0131 sonras\u0131nda hipotansiyon ve bradikardi geli\u015fen hastada, yap\u0131lan rutin tedavilere (norepinefrin, kalsiyum glukonate, magnezyum s\u00fclfat, vitamin E, NAC ve glukoz-insulin infuzyonu) ra\u011fmen mevcut durumunun progrese olmas\u0131, metabolik asidozunun derinle\u015fmesi \u00fczerine VA-ECMO\u2019ya ba\u011flanm\u0131\u015f. Hasta 3 g\u00fcnl\u00fck bir ECMO tedavisi ve di\u011fer destek tedavileriyle beraber hastaneden herhangi bir semptomu olmadan ayr\u0131lm\u0131\u015f (11).<\/span><\/span><\/p>\n

Maskell KF. ve arkada\u015flar\u0131n\u0131n yay\u0131nlad\u0131klar\u0131 vaka raporunda ise 17 ya\u015f\u0131nda a\u015f\u0131r\u0131 doz amlodipin, metaprolol, kafein al\u0131m\u0131 sonras\u0131nda; hipotansiyonu ve bradikardisi geli\u015fen hastada ilerleyen dakikalarda yap\u0131lan t\u00fcm destekleyici ve antagonist tedavilere ra\u011fmen 2 kere arrest geli\u015fmi\u015f. Hastan\u0131n ba\u015far\u0131l\u0131 resusitasyonun ard\u0131ndan hastaya VA-ECMO ba\u011flanmas\u0131 ile beraber 2 g\u00fcnl\u00fck bir s\u00fcre\u00e7te tedavisine devam edilmi\u015f. Weaning a\u015famas\u0131ndan sonra n\u00f6rolojik olarak intakt g\u00f6zlenen hastan\u0131n pediatrik servis takibinin ard\u0131ndan sa\u011fl\u0131kl\u0131 bir \u015fekilde hastaneden taburcu oldu\u011fu g\u00f6zlenmi\u015f. Ara\u015ft\u0131rmac\u0131 \u00f6zellikle kardiyotoksik ila\u00e7 al\u0131m\u0131na ikincil g\u00f6zlenen zehirlenme durumlar\u0131nda VA-ECMO\u2019nun ba\u015far\u0131l\u0131 bir y\u00f6ntem oldu\u011funu belirtiyor (12).<\/span><\/span><\/p>\n

Genellikle, ihtiya\u00e7 duyulan VA-ECMO’nun s\u00fcresi, 1-3 g\u00fcn ile s\u0131n\u0131rl\u0131d\u0131r; bu s\u00fcre zarf\u0131nda, zehirlenmenin etkisi ciddi, kal\u0131c\u0131 olmad\u0131k\u00e7a, hasta zehirlenme durumundan kurtulur. Organ toksisitesi s\u00fcr\u00fcyor ise ECMO, s\u00fcrekli veno-ven\u00f6z hemodiyalizasyon\/hemodiyaliz (CVVHDF \/ HD) ile kombine edilebilir. Bu s\u00fcre\u00e7te, toksik bile\u015fik v\u00fccuttan CVVHDF\/HD ile \u00f6nemli oranda ayr\u0131labilmektedir. ECMO’nun CVVHDF\/HD ile kombinasyonu yar\u0131lanma \u00f6mr\u00fc uzun olan toksik maddelerde d\u00fc\u015f\u00fcn\u00fclmelidir (1).<\/span><\/span><\/p>\n

Ya\u015fam\u0131 tehdit eden, hemodinamik dengesizli\u011fi olan ciddi ila\u00e7 zehirlenmelerinde hacim ihtiyac\u0131n\u0131n kar\u015f\u0131lanmas\u0131, inotrop deste\u011fi ve vazokonstrikt\u00f6rler ve (bazen) intra-aortik balon pompas\u0131na ra\u011fmen \u015fokun devam etti\u011fi durumlarda VA-ECMO g\u00f6z \u00f6n\u00fcne al\u0131nmal\u0131d\u0131r. \u00d6zellikle Acil Servis ve YB\u00dc\u2019lerde bu tabloya sebebiyet verebilecek olan kalsiyum kanal antagonistleri, beta blokerler, trisiklik antidepresanlar, klorokin gibi ila\u00e7lar\u0131n zehirlenmeleri \u00f6rnek g\u00f6sterilebilir (1).<\/span><\/span><\/p>\n

Son olarak, genel kullan\u0131mda ve toksikolojideki ECMO kullan\u0131m\u0131 i\u00e7in ELSO (Extracorporeal Life Support Organization)\u2019ya kulak vermekte fayda oldu\u011funu d\u00fc\u015f\u00fcn\u00fcyorum.<\/span><\/span><\/p>\n

ECMO hastan\u0131n mortalite riskinin \u00e7ok y\u00fcksek oldu\u011fu, geleneksel y\u00f6ntemlerin i\u015fe yaramad\u0131\u011f\u0131 durumlarda son se\u00e7enek olarak kullan\u0131lmal\u0131d\u0131r ve mortalite riskinin y\u00fcksek oldu\u011fu bilinmelidir (3).<\/span><\/span><\/p>\n

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KAYNAKLAR<\/span><\/span><\/strong><\/u><\/h2>\n

1.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 De Lange D, Sikma M, Meulenbelt J. Extracorporeal membrane oxygenation in the treatment of poisoned patients. Clinical Toxicology. 2013;51(5):385-93.<\/span><\/span><\/p>\n

2.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pretorius V, Alayadhi W, Modry D. Extracorporeal life support for the control of life-threatening pulmonary hemorrhage. The Annals of thoracic surgery. 2009;88(2):649-50.<\/span><\/span><\/p>\n

3.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Makdisi G, Wang I-w. Extra Corporeal Membrane Oxygenation (ECMO) review of a lifesaving technology. Journal of thoracic disease. 2015;7(7):E166.<\/span><\/span><\/p>\n

4.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cove ME, MacLaren G. Clinical review: mechanical circulatory support for cardiogenic shock complicating acute myocardial infarction. Critical Care. 2010;14(5):235.<\/span><\/span><\/p>\n

5.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. Journal of the American College of Cardiology. 2014;63(25 Part A):2769-78.<\/span><\/span><\/p>\n

6.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Masson R, Colas V, Parienti J-J, Lehoux P, Massetti M, Charbonneau P, et al. A comparison of survival with and without extracorporeal life support treatment for severe poisoning due to drug intoxication. Resuscitation. 2012;83(11):1413-7.<\/span><\/span><\/p>\n

7.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Daubin C, Lehoux P, Ivascau C, Tasle M, Bousta M, Lepage O, et al. Extracorporeal life support in severe drug intoxication: a retrospective cohort study of seventeen cases. Critical Care. 2009;13(4):R138.<\/span><\/span><\/p>\n

8.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Wang G, Levitan R, Wiegand T, Lowry J, Schult R, Yin S, et al. Extracorporeal membrane oxygenation (ecmo) for severe toxicological exposures: review of the toxicology investigators consortium (toxic). Journal of Medical Toxicology. 2016;12(1):95-9.<\/span><\/span><\/p>\n

9.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Heise CW, Skolnik AB, Raschke RA, Owen-Reece H, Graeme KA. Two cases of refractory cardiogenic shock secondary to Bupropion successfully treated with veno-arterial extracorporeal membrane oxygenation. Journal of Medical Toxicology. 2016;12(3):301-4.<\/span><\/span><\/p>\n

10.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Escajeda JT, Katz KD, Rittenberger JC. Successful treatment of metoprolol-induced cardiac arrest with high-dose insulin, lipid emulsion, and ECMO. The American journal of emergency medicine. 2015;33(8):1111. e1.<\/span><\/span><\/p>\n

11.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hassanian\u2010Moghaddam H, Zamani N, Rahimi M, Hajesmaeili M, Taherkhani M, Sadeghi R. Successful treatment of aluminium phosphide poisoning by extracorporeal membrane oxygenation. Basic & clinical pharmacology & toxicology. 2016;118(3):243-6.<\/span><\/span><\/p>\n

12.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Maskell KF, Ferguson NM, Bain J, Wills BK. Survival after cardiac arrest: ECMO rescue therapy after amlodipine and metoprolol overdose. Cardiovascular toxicology. 2017;17(2):223-5.<\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Dr. Erdem Kurt<\/em><\/p>\n

\u2018\u2019Ekstrakorporal\u2019\u2019 v\u00fccut d\u0131\u015f\u0131 anlam\u0131na gelmekle beraber ekstrakorporal tedavi bi\u00e7imleri egzojen veya endojen zehirleri v\u00fccuttan uzakla\u015ft\u0131ran, hayati bir organ\u0131 destekleyen ya da ge\u00e7ici bir s\u00fcre onun yerine ge\u00e7en heterojen tedavi gruplar\u0131d\u0131r.
\nEkstrakorporal membran oksijenasyonu (ECMO) 1972’de piyasaya s\u00fcr\u00fclmesinden sonra bir\u00e7ok hastada kullan\u0131lmas\u0131na ra\u011fmen, bir\u00e7ok klinik yeti\u015fkin hastalarda bu deneysel tedaviyi terk etmi\u015ftir. ECMO devresinde kullan\u0131lan aparatlar\u0131n biyo-uyumunun artt\u0131r\u0131lmas\u0131yla beraber 2009 y\u0131l\u0131nda geli\u015fen A\/H1N1 pandemisi s\u0131ras\u0131ndaki ARDS vakalar\u0131nda ECMO kullan\u0131lmas\u0131 ve tedavi edilen hastalar\u0131n \u015fa\u015f\u0131rt\u0131c\u0131 derecede d\u00fc\u015f\u00fck mortalite ile seyretmesi d\u00fcnya \u00e7ap\u0131ndaki bir\u00e7ok yo\u011fun bak\u0131m biriminde ECMO’nun yeniden tercih edilmesine sebep oldu (1). Bu tarihten itibaren ECMO\u2019nun kardiyotorasik hastalarda respiratuvar ve dola\u015f\u0131msal destek amac\u0131yla kullan\u0131m\u0131n\u0131n artmas\u0131, ciddi zehirlenme olgular\u0131nda geli\u015fen refrakter dola\u015f\u0131msal \u015fok ve ARDS gibi durumlar i\u00e7in yeni bir tedavi se\u00e7ene\u011fini do\u011furmu\u015ftur (1).
\nECMO ayn\u0131 zamanda Ekstrakorporal Ya\u015fam Deste\u011fi(ECLS) olarak bilinmekle beraber, geriye d\u00f6nd\u00fcr\u00fclebilir bir nedenden \u00f6t\u00fcr\u00fc kardiyak ve solunumsal yetersizli\u011fi olan bir hastada bu durumun giderilmesi i\u00e7in hastaya zaman kazand\u0131r\u0131lmas\u0131n\u0131 sa\u011flayan bir m\u00fcdahale bi\u00e7imidir.<\/p>\n","protected":false},"author":1083,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10014],"tags":[136,138,406],"class_list":["post-554","post","type-post","status-publish","format-standard","hentry","category-akademik-blog-yazisi","tag-ecmo","tag-ekstrakorporal-membran-oksijenizasyonu","tag-toksikoloji"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/554","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/users\/1083"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=554"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/554\/revisions"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=554"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=554"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=554"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}