Reeb Jérémie, Falcoz Pierre-Emmanuel, Santelmo Nicola, Massard Gilbert
Department of Thoracic Surgery, Lung Transplantation Team, Nouvel Hôpital Civil, University Hospital, Strasbourg, France.
Interact Cardiovasc Thorac Surg. 2012 Jan;14(1):125-7. doi: 10.1093/icvts/ivr046. Epub 2011 Nov 17.
Extracorporeal membrane oxygenation (ECMO) is used for refractory respiratory failure. Normally, ECMO is implanted in intubated patients as a last resort. We report the case of a non-intubated patient who benefited from veno-venous (VV) ECMO. A 35-year old cystic fibrosis man presented a severe respiratory decompensation with refractory hypercapnia. We opted for an ECMO instead of mechanical ventilation (MV). We implanted a double lumen bi-cava cannula (DLC) (Avalon Elite(TM)) in the right jugular vein. Before ECMO implantation, the patient presented refractory respiratory failure (pH = 7.1, PaO(2) = 83 mmHg, PaCO(2 )= 103 mmHg). We proposed that the patient be placed on the high emergency lung transplantation waiting list after failure to wean him from ECMO. This registration was effective 10 days after ECMO implantation. The patient was grafted the next day. Under ECMO, mean PaO(2), PaCO(2) and TCA were 80.6 ± 14.2, 53.8 ± 6.4 mmHg and 56.2 ± 9.7 s, respectively. The patient could eat, drink, talk and practice chest physiotherapy. The evolution was uneventful under ECMO. Weaning from ECMO was done in the operating theatre after transplantation. VV ECMO with DLC is safe and feasible in non-intubated patients. It avoids potential complications of MV, and allows respiratory assistance as bridge to transplantation.
体外膜肺氧合（ECMO）用于治疗难治性呼吸衰竭。通常情况下，ECMO作为最后手段植入已插管患者体内。我们报告了一例非插管患者受益于静脉-静脉（VV）ECMO的病例。一名35岁的囊性纤维化男性出现严重呼吸代偿失调并伴有难治性高碳酸血症。我们选择了ECMO而非机械通气（MV）。我们在右颈静脉植入了双腔双腔静脉插管（DLC）（Avalon Elite™）。在植入ECMO之前，患者出现难治性呼吸衰竭（pH = 7.1，PaO₂ = 83 mmHg，PaCO₂ = 103 mmHg）。在尝试使患者脱离ECMO失败后，我们建议将其列入紧急肺移植高优先级等待名单。该登记在ECMO植入后10天生效。患者于次日接受移植。在ECMO支持下，平均PaO₂、PaCO₂和TCA分别为80.6±14.2、53.8±6.4 mmHg和56.2±9.7秒。患者能够进食、饮水、交谈并进行胸部物理治疗。在ECMO支持下病情进展平稳。移植后在手术室撤离ECMO。采用DLC的VV ECMO在非插管患者中安全可行。它避免了MV的潜在并发症，并允许作为移植桥梁进行呼吸支持。
