Service de Réanimation Médicale, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris, France.
Crit Care Med. 2013 Jul;41(7):1616-26. doi: 10.1097/CCM.0b013e31828a2370.
Profound myocardial depression can occur during severe septic shock. Although good outcomes of venoarterial extracorporeal membrane oxygenation-treated children with refractory septic shock have been reported, little is known about adults' outcomes. This study was designed to assess the outcomes and long-term health-related quality-of-life of patients supported by venoarterial extracorporeal membrane oxygenation for refractory cardiac and hemodynamic failure during severe septic shock.
A retrospective, single-center, observational study and a cross-sectional survey to assess health-related quality of life by the Short Form-36 questionnaire and frequencies of anxiety, depression and posttraumatic stress disorder symptoms by the Hospital Anxiety and Depression Scale and the Impact of Event Scale, respectively.
A 26-bed tertiary intensive care unit in a university hospital.
We evaluated the outcomes of patients who received venoarterial extracorporeal membrane oxygenation rescue therapy for refractory cardiovascular failure during bacterial septic shock. Results are expressed as medians (range).
From January 2008 to September 2011, 14 patients, 45 years old (28-66), seven males, none with a history of left ventricular dysfunction, received venoarterial extracorporeal membrane oxygenation for septic shock refractory to conventional treatment, 24 hours (3-108) after shock onset. All exhibited severe myocardial dysfunction at extracorporeal membrane oxygenation implantation. Left ventricular ejection fraction was 16% (10% to 30%), cardiac index was 1.3 L/min/m (0.7-2.2 ) and systemic resistance vascular index was 3162 (2047-7685). All were receiving high-dose catecholamines and had signs of multiple organ failure: pH 7.16 (6.68-7.39), blood lactate 9 (2-17) mmol/L, PaO2/FIO2 87 (28-364), Simplified Acute Physiology Score III 84 (75-106) and Sepsis-Related Organ Failure Assessment score 18 (8-21). Twelve patients (86%) could be weaned off venoarterial extracorporeal membrane oxygenation after 5.5 days (2-12) days of support and 10 patients (71%) were discharged to home and were alive after a median follow-up of 13 months (3-43). All 10 survivors had normal left ventricular ejection fraction and reported good health-related quality of life at long-term follow-up.
Venoarterial extracorporeal membrane oxygenation rescued more than 70% of the patients who developed refractory cardiovascular dysfunction during severe bacterial septic shock. Survivors reported good long-term quality of life. Venoarterial extracorporeal membrane oxygenation might represent a valuable therapeutic option for adults in severe septic shock with refractory cardiac and hemodynamic failure.
严重脓毒症休克期间可能会出现深度心肌抑制。虽然已有研究报道，使用静脉-动脉体外膜肺氧合（VA-ECMO）治疗难治性脓毒性休克的儿童有较好的结局，但成人的结局却知之甚少。本研究旨在评估 VA-ECMO 治疗难治性心源性和血液动力学衰竭的严重脓毒症休克患者的结局和长期健康相关生活质量。
回顾性、单中心、观察性研究和横断面调查，分别使用 36 项简短健康调查问卷评估健康相关生活质量，使用医院焦虑抑郁量表和事件影响量表评估焦虑、抑郁和创伤后应激障碍症状的频率。
大学医院 26 张床位的重症监护病房。
我们评估了因细菌性脓毒性休克并发难治性心血管衰竭而接受 VA-ECMO 抢救治疗的患者的结局。结果以中位数（范围）表示。
2008 年 1 月至 2011 年 9 月，14 名年龄 45 岁（28-66 岁）、7 名男性、无左心室功能障碍病史的患者在脓毒性休克发作后 24 小时（3-108 小时）接受了 VA-ECMO 治疗难治性休克。所有患者在接受 ECMO 治疗时均存在严重的心肌功能障碍。左心室射血分数为 16%（10%-30%），心指数为 1.3 L/min/m（0.7-2.2），全身血管阻力指数为 3162（2047-7685）。所有患者均接受大剂量儿茶酚胺治疗，且存在多器官衰竭的迹象：pH 值 7.16（6.68-7.39），血乳酸 9（2-17）mmol/L，PaO2/FIO2 87（28-364），简化急性生理学评分Ⅲ 84（75-106），脓毒症相关器官衰竭评估评分 18（8-21）。12 名患者（86%）在接受 ECMO 支持 5.5 天后（2-12 天）可以脱机，10 名患者（71%）出院回家，中位随访 13 个月（3-43 个月）后仍存活。所有 10 名幸存者的左心室射血分数正常，长期随访时报告健康相关生活质量良好。
VA-ECMO 挽救了超过 70%在严重细菌性脓毒症休克期间出现难治性心血管功能障碍的患者。幸存者报告了良好的长期生活质量。VA-ECMO 可能是严重脓毒症休克伴难治性心功能和血液动力学衰竭患者的一种有价值的治疗选择。
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