Sievert Alicia N, Shackelford Anthony G, McCall Mary M
Cardiovascular Perfusion Program, College of Health Professions, Medical University of South Carolina, 151B Rutledge Ave., PO Box 250964, Charleston, SC 29425, USA.
J Extra Corpor Technol. 2009 Jun;41(2):73-8.
Extracorporeal life support (ECLS) is a procedure used to support the failing heart and/or lungs via a heart lung machine. Over 145 institutions perform this practice in the United States with more than 24,000 ECLS cases recorded. While many articles are published each year on common perfusion practice, little information is shared on emerging technologies in ECLS and common practices among perfusionists and ECLS specialists. This article presents our 2006 ECLS survey results and discusses emerging technologies and management topics new to the ECLS arena. ECLS specialists were asked to participate in an online survey. Two hundred twenty-two ECLS specialists responded. This survey suggests positive displacement roller pumps are still the leading pump used for ECLS 122/188 (64.9%). Silicone membrane oxygenators are used by responders 75% of the time for long-term use, while hollow fiber membrane oxygenators are used 44%. Forty-five percent of responders are using heparin or biocoated circuits exclusively, while 14.6% restrict their use to specific subpopulations. The most common coating is heparin coating (67.9%). Activated clotting time (ACT) management is still standard of care for coagulation monitoring (98%), while partial thromboplastin time (PTT) follows at 71.7%. The interquartile range for ACTs is 160-220 seconds and 160-200 seconds with active bleeding. This article suggests ECLS specialists are beginning to incorporate different technology into their practice, such as centrifugal pumps with hollow fiber oxygenators and coated-circuits.
体外生命支持（ECLS）是一种通过心肺机来支持衰竭心脏和/或肺脏的治疗手段。在美国，有超过145家机构开展此项治疗，记录的ECLS病例超过24000例。尽管每年都有许多关于常规灌注实践的文章发表，但关于ECLS新兴技术以及灌注师和ECLS专家的常规操作的信息却很少被分享。本文展示了我们2006年ECLS的调查结果，并讨论了ECLS领域的新兴技术和管理新话题。我们邀请ECLS专家参与一项在线调查。222位ECLS专家做出了回应。这项调查表明，正位移滚压泵仍是用于ECLS的主要泵型，有122/188（64.9%）。75%的回应者在长期使用时会选择硅酮膜式氧合器，而中空纤维膜式氧合器的使用率为44%。45%的回应者仅使用肝素或生物涂层回路，而14.6%的人将其使用限制在特定亚人群中。最常见的涂层是肝素涂层（67.9%）。活化凝血时间（ACT）管理仍是凝血监测的标准护理方法（98%），而部分凝血活酶时间（PTT）的使用率为71.7%。ACT的四分位间距在无活动性出血时为160 - 220秒，有活动性出血时为160 - 200秒。本文表明，ECLS专家开始将不同技术纳入其操作中，如使用带中空纤维氧合器的离心泵和涂层回路。
