Lee Woo Surng, Chee Hyun Keun, Song Meong Gun, Kim Yo Han, Shin Je Kyoun, Kim Jun Seok, Lee Song Am, Hwang Jae Joon
Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Korea.
Korean J Thorac Cardiovasc Surg. 2011 Feb;44(1):9-17. doi: 10.5090/kjtcs.2011.44.1.9. Epub 2011 Feb 12.
A peripheral extracorporeal membrane oxygenator (p-ECMO) has been developed to support patients who are dying due to a serious cardiopulmonary condition. This analysis was planned to define the clinical situation in which the patient benefits most from a p-ECMO.
Between June 2007 and Aug 2009, a total of 41 adult patients used the p-ECMO. There were 23 males and 18 females (mean age 54.4±15.1 years). All patients had very unstable vital signs with hypoxia and complex cardiac problems. We divided the patients into 4 groups. In the first group, a p-ECMO was used as a bridge to cardiac operation. In the second group, patients did not have the opportunity to undergo any cardiac procedures; nevertheless, they were treated with a p-ECMO. In the third group, patients mostly had difficulty in weaning from CPB (cardiopulmonary bypass) after cardiac operation. The fourth group suffered from many complications, such as pneumonia, bleeding, infections, and LV dysfunction with underlying cardiac problems. All cannulations were performed by the Seldinger technique or cutting down the femoral vessel. A long venous cannula of DLP® (Medtronic Inc, Minneapolis, MN) or RMI® (Edwards Lifesciences LLC, Irvine, CA) was used together with a 1721 Fr arterial cannula and a 21 Fr venous cannula. As a bypass pump, a Capiox emergency bypass system (EBS®; Terumo, Tokyo, Japan) was used. We attempted to maintain a flow rate of 2.43.0 L/min/m(2) and an activated clotting time (ACT) of around 180 seconds.
Nine patients survived by the use of the p-ECMO. Ten patients were weaned from a p-ECMO but they did not survive, and the remainder had no chance to be weaned from the p-ECMO. The best clinical situation to apply the p-ECMO was to use it as a bridge to cardiac operation and for weaning from CPB after cardiac operation.
Various clinical results were derived by p-ECMO according to the clinical situation. For the best results, early adoption of the p-ECMO for anatomical correction appears important.
一种外周体外膜肺氧合器（p-ECMO）已被研发出来，用于支持因严重心肺疾病濒临死亡的患者。本分析旨在确定患者能从p-ECMO中获益最大的临床情况。
2007年6月至2009年8月期间，共有41例成年患者使用了p-ECMO。其中男性23例，女性18例（平均年龄54.4±15.1岁）。所有患者生命体征极不稳定，伴有低氧血症和复杂的心脏问题。我们将患者分为4组。第一组，p-ECMO用作心脏手术的桥梁。第二组，患者没有机会接受任何心脏手术；尽管如此，他们仍接受了p-ECMO治疗。第三组，患者心脏手术后大多难以脱离体外循环（CPB）。第四组患有多种并发症，如肺炎、出血、感染以及伴有潜在心脏问题的左心室功能障碍。所有插管均采用Seldinger技术或切开股血管进行。使用DLP®（美敦力公司，明尼阿波利斯，明尼苏达州）或RMI®（爱德华生命科学有限责任公司，尔湾，加利福尼亚州）的长静脉插管，以及1721 Fr的动脉插管和21 Fr的静脉插管。作为体外循环泵，使用了Capiox紧急体外循环系统（EBS®；日本东京泰尔茂公司）。我们试图将流速维持在2.43.0 L/min/m²，活化凝血时间（ACT）维持在180秒左右。
9例患者通过使用p-ECMO存活。10例患者脱离了p-ECMO，但未存活，其余患者没有机会脱离p-ECMO。应用p-ECMO的最佳临床情况是将其用作心脏手术的桥梁以及心脏手术后脱离CPB。
根据临床情况，p-ECMO产生了不同的临床结果。为获得最佳效果，早期采用p-ECMO进行解剖矫正似乎很重要。
