Arlt Matthias, Philipp Alois, Zimmermann Markus, Voelkel Sabine, Amann Matthias, Bein Thomas, Müller Thomas, Foltan Maik, Schmid Christof, Graf Bernhard, Hilker Michael
Department of Anesthesiology, Air-Medical Service, University Hospital Regensburg, Regensburg, Germany.
Artif Organs. 2009 Sep;33(9):696-703. doi: 10.1111/j.1525-1594.2009.00860.x.
Severe pulmonary and cardiopulmonary failure resistant to critical care treatment leads to hypoxemia and hypoxia-dependent organ failure. New treatment options for cardiopulmonary failure are necessary even for patients in outlying medical facilities. If these patients are in need of specialized center treatment, additional emergency medical service has to be carried out quick and safely. We describe our experiences with a pumpless extracorporeal lung assist (PECLA/iLA) for out-of-center emergency treatment of hypercapnic respiratory failure and the use of a newly developed hand-held extracorporeal membrane oxygenation (ECMO) system in cardiac, pulmonary, and cardiopulmonary failure (EMERGENCY-LIFE Support System, ELS System, MAQUET Cardiopulmonary AG, Hechingen, Germany). Between March 2000 and April 2009, we used the PECLA System (n = 20) and the ELS System (n = 33) in adult patients. Cannulation was employed using percutaneous vessel access. The new hand-held ELS System consists of a centrifugal pump and a membrane oxygenator, both mounted on a special holder system for storing on a standard patient gurney for air or ground ambulance transfer. Bedside cannulation processes were uneventful. The PECLA System resulted in sufficient CO(2) removal. In all ECMO patients, oxygen delivery and systemic blood flow could be restored and vasopressor support was markedly down. Hospital survival rate in the PECLA group was 50%, and 61% in the ECMO group. Out-of-center emergency treatment of hypercapnic pulmonary failure with pumpless extracorporeal gas exchange and treatment of cardiac, pulmonary, and cardiopulmonary failure with this new hand-held ECMO device is safe and highlyeffective. Patient outcome in cardiopulmonary organ failure could be improved.
对重症监护治疗耐药的严重肺和心肺衰竭会导致低氧血症和依赖低氧的器官衰竭。即使对于偏远地区医疗机构的患者，心肺衰竭也需要新的治疗方案。如果这些患者需要专科中心治疗，就必须快速且安全地开展额外的紧急医疗服务。我们描述了使用无泵体外肺辅助（PECLA/iLA）对高碳酸血症性呼吸衰竭进行中心外紧急治疗的经验，以及在心脏、肺和心肺衰竭中使用新开发的手持式体外膜肺氧合（ECMO）系统（紧急生命支持系统，ELS系统，德国黑兴根迈柯唯心肺股份公司）的经验。2000年3月至2009年4月期间，我们在成年患者中使用了PECLA系统（n = 20）和ELS系统（n = 33）。采用经皮血管穿刺置管。新型手持式ELS系统由一个离心泵和一个膜式氧合器组成，两者均安装在一个特殊的支架系统上，以便存储在标准患者推车上用于空中或地面救护车转运。床边置管过程顺利。PECLA系统实现了充分的二氧化碳清除。在所有ECMO患者中，氧输送和全身血流得以恢复，血管升压药支持显著减少。PECLA组的医院生存率为50%，ECMO组为61%。使用无泵体外气体交换对高碳酸血症性肺衰竭进行中心外紧急治疗，以及使用这种新型手持式ECMO设备治疗心脏、肺和心肺衰竭是安全且高效的。心肺器官衰竭患者的预后可以得到改善。
