Cedars-Sinai Heart Institute, Los Angeles, California 90211, USA.
J Heart Lung Transplant. 2011 Nov;30(11):1250-6. doi: 10.1016/j.healun.2011.05.006. Epub 2011 Jun 14.
Extracorporeal membrane oxygenation (ECMO) provides hemodynamic support in refractory cardiogenic shock and may be used after heart transplantation for primary graft dysfunction or rejection. We hypothesized that survival after ECMO support is contingent upon patient selection.
We examined consecutive adult heart transplant recipients at a single center who underwent transplantation between 1997 and 2009 and required ECMO support. Patients were divided by clinical presentation: pre-emptive therapy, escalating inotropic requirements despite support by intra-aortic balloon pump (IABP); and salvage therapy, cardiac arrest undergoing cardiopulmonary resuscitation with chest compressions.
Between 1997 and 2009, there were 37 instances of ECMO use in 32 patients: 23 episodes (19 patients) for pre-emptive therapy and 14 episodes (14 patients) for salvage therapy; 1 patient had both pre-emptive and salvage therapy. Patients did not differ in age, gender or ischemic time. ECMO support was for a median 6 days in both groups, and the incidence of serious vascular complications was comparable (35% and 36%). In the pre-emptive therapy group, 15 episodes (79%) were associated with survival to hospital discharge and 5 patients (26%) were alive at 1 year. In the salvage therapy group, 2 episodes (14%) were associated with survival to hospital discharge and 1 patient (7%) was alive at 1 year.
ECMO support is a viable option for adult heart transplant recipients with severe rejection and refractory cardiogenic shock. To maximize the benefit of this aggressive approach in heart transplant recipients requires early intervention, with a heightened awareness of this option to facilitate expedited use.
体外膜肺氧合（ECMO）为难治性心源性休克提供血液动力学支持，并且在心脏移植后可能用于原发性移植物功能障碍或排斥反应。我们假设 ECMO 支持后的存活率取决于患者的选择。
我们检查了 1997 年至 2009 年期间在一家中心进行的连续成年心脏移植受者，这些患者需要 ECMO 支持。根据临床表现将患者分为：预先治疗，尽管使用主动脉内球囊泵（IABP）支持，但仍需要增加心肌收缩力；和抢救治疗，心脏骤停进行心肺复苏，胸部按压。
1997 年至 2009 年期间，32 例患者中有 37 例使用 ECMO：23 例（19 例）为预先治疗，14 例（14 例）为抢救治疗；1 例患者同时进行了预先治疗和抢救治疗。患者在年龄、性别或缺血时间方面没有差异。两组 ECMO 支持的中位时间均为 6 天，严重血管并发症的发生率相当（35%和 36%）。在预先治疗组中，15 例（79%）与住院期间存活相关，5 例（26%）在 1 年内存活。在抢救治疗组中，2 例（14%）与住院期间存活相关，1 例（7%）在 1 年内存活。
ECMO 支持是严重排斥反应和难治性心源性休克成年心脏移植受者的可行选择。要使这种积极方法在心脏移植受者中最大限度地发挥作用，需要早期干预，并提高对这种选择的认识，以促进加快使用。
