Lee Seung Hyun, Chung Cheol Hyun, Lee Jae Won, Jung Sung Ho, Choo Suk Jung
Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, University of Keimyung College of Medicine, Daegu, Korea.
J Card Surg. 2012 Mar;27(2):255-63. doi: 10.1111/j.1540-8191.2011.01400.x. Epub 2012 Feb 26.
Extracorporeal membrane oxygenation (ECMO) is an established treatment option in patients with cardiogenic shock and respiratory dysfunction. We assessed outcomes of ECMO, as well as predictors of ECMO weaning and survival, in patients treated in our institution over the past five years.
We reviewed the records of 185 patients who received ECMO support for various medical conditions between January 2005 and January 2010. Risk factors for successful weaning, early mortality, and overall survival were investigated.
There were 101 males and 84 females, and the mean age was 56.1 ± 14.7 years. Patients received either venoarterial (n = 137) or veno-veno (n = 48) ECMO. ECMO was instituted in stable patients (n = 40, 21.6%), those in shock (n = 105, 56.8%), or those in cardiac arrest (n = 40, 21.6%). Mean ECMO support lasted 4.7 days and weaning was successful in 68 patients (36.7%), with 38 (20.5%) eventually being discharged from the hospital. Univariate analysis showed hemodynamic status at insertion (p = 0.05) including intra-aortic balloon pump usage to significantly influence successful weaning, whereas the duration of ECMO was strongly associated with overall survival (p = 0.05).
Early ECMO application before catastrophic clinical deterioration and weaning as soon as possible may enhance overall survival.
体外膜肺氧合（ECMO）是治疗心源性休克和呼吸功能障碍患者的一种既定治疗选择。我们评估了过去五年在我院接受治疗的患者中ECMO的治疗效果，以及ECMO撤机和生存的预测因素。
我们回顾了2005年1月至2010年1月期间185例因各种医疗状况接受ECMO支持的患者的记录。研究了成功撤机、早期死亡率和总体生存率的危险因素。
男性101例，女性84例，平均年龄56.1±14.7岁。患者接受静脉-动脉（n = 137）或静脉-静脉（n = 48）ECMO。ECMO应用于病情稳定的患者（n = 40，21.6%）、休克患者（n = 105，56.8%）或心脏骤停患者（n = 40，21.6%）。ECMO平均支持时间为4.7天，68例患者（36.7%）撤机成功，38例（20.5%）最终出院。单因素分析显示，置管时的血流动力学状态（p = 0.05），包括主动脉内球囊反搏的使用，对成功撤机有显著影响，而ECMO的持续时间与总体生存率密切相关（p = 0.05）。
在临床灾难性恶化前尽早应用ECMO并尽快撤机可能会提高总体生存率。
