Vardi Amir, Abed Machmood, Mishali David, Levin Inbal, Paret Gideon, Barzilay Zohar
Department of Pediatric Critical Care, Sheba Medical Center, Tel Hashomer, Israel.
Harefuah. 2003 Sep;142(8-9):583-7, 648, 647.
ECMO is used as a method for mechanical life support in the face of extreme cardiopulmonary failure. Most children and neonates that require ECMO do so because of respiratory failure unresponsive to conventional supportive measures. Less then 16% of the patients require ECMO support for the failing heart. The Sheba Medical Center, is one of two centers in Israel authorized by the Ministry of Health to use ECMO technique and is the only center that also performs pediatric cardiac surgery.
To present our experience with ECMO support in patients with low cardiac output syndromes following open-heart surgery for congenital cardiac anomalies as compared to international experience.
The charts of all pediatric and neonatal patients requiring ECMO support following cardiac surgery for complex congenital cardiac anomalies were reviewed. Patient and ECMO characteristics were compared, as well as the success rates.
Between 1995 and 2001, sixteen neonates and children were treated at our institution by ECMO for low cardiac output syndromes following heart surgery. Twelve were operated on at our institution, and four were referred to the ECMO unit of our pediatric critical care ward from other hospitals. ECMO support resulted in full recovery in seven of the sixteen patients, cardiac function returned to normal and the patients were discharged home in good condition, nine patients died.
Our experience is in accord with the reported international experience. Following cardiac surgery for congenital cardiac anomalies, low cardiac output, unresponsive to maximal conventional medical support, is a rare but life threatening condition. Extracorporeal membrane oxygenation serves as a rescue mechanical support for these patients and due to improved and sophisticated intensive care, can serve as a bridge to recovery. The availability of ECMO provides an extra margin of safety in the very complex cases of open-heart surgery.
体外膜肺氧合（ECMO）被用作面对极端心肺功能衰竭时的机械生命支持方法。大多数需要ECMO的儿童和新生儿是因为对传统支持措施无反应的呼吸衰竭。不到16%的患者因心脏衰竭需要ECMO支持。舍巴医疗中心是以色列卫生部授权使用ECMO技术的两个中心之一，也是唯一一家还开展小儿心脏手术的中心。
与国际经验相比，介绍我们在先天性心脏畸形心脏直视手术后低心排血量综合征患者中使用ECMO支持的经验。
回顾了所有因复杂先天性心脏畸形心脏手术后需要ECMO支持的儿科和新生儿患者的病历。比较了患者和ECMO的特征以及成功率。
1995年至2001年期间，我们机构对16例新生儿和儿童进行了ECMO治疗，用于心脏手术后的低心排血量综合征。其中12例在我们机构接受手术，4例从其他医院转入我们儿科重症监护病房的ECMO单元。ECMO支持使16例患者中的7例完全康复，心脏功能恢复正常，患者状况良好出院，9例患者死亡。
我们的经验与报道的国际经验一致。先天性心脏畸形心脏手术后，低心排血量且对最大程度的传统医学支持无反应是一种罕见但危及生命的情况。体外膜肺氧合为这些患者提供了一种挽救性的机械支持，并且由于改进和复杂的重症监护，可作为恢复的桥梁。ECMO的可用性在非常复杂的心脏直视手术病例中提供了额外的安全边际。
