Martin G R, Short B L, Abbott C, O'Brien A M
Department of Cardiology, Children's National Medical Center, Washington, D.C.
J Thorac Cardiovasc Surg. 1991 Apr;101(4):607-11.
Previous studies have shown that cardiac performance decreases in infants undergoing extracorporeal membrane oxygenation (ECMO). Some infants have an exaggerated decrease in cardiac performance during ECMO. This syndrome has been called cardiac stun. To better understand this phenomenon, we reviewed the records of infants with cardiac stun and compared them with infants who did not have the syndrome. Cardiac stun was detected in 12 of 240 infants (5.0%) undergoing ECMO. The diagnoses were congenital diaphragmatic hernia (7/12), meconium aspiration syndrome (3/12), respiratory distress syndrome (1/12), and persistent pulmonary hypertension of the newborn (1/12). The weight, gestational age, inotropic support, and time to start of ECMO were similar to infants without cardiac stun. Arterial oxygen tension was lower, carbon dioxide tension was higher, and pH was lower before ECMO in infants in whom cardiac stun developed (p less than or equal to 0.03). Cardiac arrests were more common, before ECMO, in infants in whom cardiac stun developed (6/12; p less than or equal to 0.01). Cardiac stun began at an average 2 1/2 hours after beginning ECMO (range 0.1 to 7 hours). Pulse pressure decreased from 20 mm Hg (range 10 to 45 mm Hg) before stun to 8 mm Hg (range 4 to 12 mm Hg) after stun. Heart rate did not change. Cardiac stun lasted for 33 hours (range 1 to 64 hours) on ECMO and recurred in three infants. Decreases in pump flow and increases in preload, afterload reduction, and inotropic agents did not improve cardiac performance. Survival was lower in the infants in whom cardiac stun developed (p less than or equal to 0.001). Only 5 of 12 infants (42%) survived ECMO when cardiac stun occurred. Our findings show that cardiac stun occurs infrequently during ECMO and is transient in most infants. Infants in whom cardiac stun develops appear to be more ill before ECMO and have a higher mortality after ECMO.
以往研究表明，接受体外膜肺氧合（ECMO）治疗的婴儿心脏功能会下降。一些婴儿在ECMO治疗期间心脏功能下降更为明显。这种综合征被称为心脏晕厥。为了更好地理解这一现象，我们回顾了患有心脏晕厥的婴儿的记录，并将其与未患该综合征的婴儿进行比较。在接受ECMO治疗的240名婴儿中，有12名（5.0%）被检测出患有心脏晕厥。诊断结果为先天性膈疝（7/12）、胎粪吸入综合征（3/12）、呼吸窘迫综合征（1/12）和新生儿持续性肺动脉高压（1/12）。其体重、胎龄、血管活性药物支持以及开始ECMO治疗的时间与未患心脏晕厥的婴儿相似。在发生心脏晕厥的婴儿中，ECMO治疗前动脉血氧分压较低，二氧化碳分压较高，pH值较低（p≤0.03）。在发生心脏晕厥的婴儿中，ECMO治疗前心脏骤停更为常见（6/12；p≤0.01）。心脏晕厥平均在开始ECMO治疗后2.5小时出现（范围为0.1至7小时）。脉压从晕厥前的20毫米汞柱（范围为10至45毫米汞柱）降至晕厥后的8毫米汞柱（范围为4至12毫米汞柱）。心率未发生变化。心脏晕厥在ECMO治疗期间持续33小时（范围为1至64小时），有3名婴儿复发。泵流量降低以及前负荷增加、后负荷降低和使用血管活性药物均未改善心脏功能。发生心脏晕厥的婴儿存活率较低（p≤0.001）。当发生心脏晕厥时，12名婴儿中只有5名（42%）在ECMO治疗后存活。我们的研究结果表明，心脏晕厥在ECMO治疗期间很少发生，且在大多数婴儿中是短暂的。发生心脏晕厥的婴儿在ECMO治疗前似乎病情更严重，且在ECMO治疗后死亡率更高。
