Maclaren Graeme, Butt Warwick
Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia.
Crit Care Resusc. 2007 Mar;9(1):76-80.
Extracorporeal membrane oxygenation (ECMO) is a controversial means of life support, particularly in adults. Ongoing refinements in circuit technology and widening global experience have led to ECMO being applied to a broader group of conditions than acute respiratory failure and cardiogenic shock. Septicaemia is no longer viewed as a contraindication to ECMO. Acute respiratory distress syndrome and bacterial pneumonia are the most common conditions in sepsis that may require ECMO, although septic shock with refractory hypotension may also be an indication under certain circumstances. The last indication is generally more applicable in children than adults, because of differences in the cardiovascular response to severe sepsis seen across age groups. ECMO has a role as rescue therapy in patients with severe sepsis who would otherwise die of either hypoxaemia or inadequate cardiac output. This review describes the basic technique and application of ECMO in neonates, older children, and adults with sepsis.
体外膜肺氧合（ECMO）是一种存在争议的生命支持手段，在成人中尤为如此。循环技术的不断改进以及全球经验的不断丰富，使得ECMO的应用范围已超出急性呼吸衰竭和心源性休克，涵盖了更广泛的病症。败血症不再被视为ECMO的禁忌证。急性呼吸窘迫综合征和细菌性肺炎是败血症中最常见的可能需要ECMO的病症，不过在某些情况下，伴有难治性低血压的感染性休克也可能是适应证。由于不同年龄组对严重败血症的心血管反应存在差异，最后这一适应证通常在儿童中比在成人中更适用。对于患有严重败血症、否则将死于低氧血症或心输出量不足的患者，ECMO可作为一种挽救疗法。本综述介绍了ECMO在患有败血症的新生儿、大龄儿童和成人中的基本技术及应用。
