Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina 27710, USA.
Respir Care. 2013 Jun;58(6):1038-52. doi: 10.4187/respcare.02255.
Extracorporeal membrane oxygenation (ECMO) is a form of cardiopulmonary bypass that is a mainstay of therapy in neonatal and pediatric patients with life threatening respiratory and/or cardiac failure. Historically, the use of ECMO in adults has been limited, but recent reports and technological advances have increased utilization and interest in this technology in adult patients with severe respiratory failure. As ECMO is considered in this critically ill population, patient selection, indications, contraindications, comorbidities, and pre-ECMO support are all important considerations. Once the decision is made to cannulate a patient for ECMO, meticulous multi-organ-system management is required, with a priority being placed on lung rest and minimization of ventilator-induced lung injury. Close monitoring is also necessary for complications, some of which are related to ECMO and others secondary to the patient's underlying degree of illness. Despite the risks, reports demonstrate survival > 70% in some circumstances for patients requiring ECMO for refractory respiratory failure. As the utilization of ECMO in adult patients with respiratory failure continues to expand, ongoing discussion and investigation are needed to determine whether ECMO should remain a "rescue" therapy or if earlier ECMO may be beneficial as a lung-protective strategy.
体外膜肺氧合（ECMO）是心肺旁路的一种形式，是治疗有生命威胁的呼吸和/或心功能衰竭的新生儿和儿科患者的主要方法。历史上，ECMO 在成人中的应用受到限制，但最近的报告和技术进步增加了对这种技术在严重呼吸衰竭的成年患者中的应用和兴趣。在考虑对这一危重病患者使用 ECMO 时，患者选择、适应证、禁忌证、合并症和 ECMO 前支持都是重要的考虑因素。一旦决定对患者进行 ECMO 插管，就需要进行细致的多器官系统管理，优先考虑肺休息和尽量减少呼吸机引起的肺损伤。还需要密切监测并发症，其中一些与 ECMO 有关，另一些与患者潜在的疾病严重程度有关。尽管存在风险，但一些报告显示，对于需要 ECMO 治疗难治性呼吸衰竭的患者，在某些情况下，生存率超过 70%。随着 ECMO 在成人呼吸衰竭患者中的应用不断扩大，需要持续讨论和研究，以确定 ECMO 是否应继续作为“抢救”治疗，或者早期 ECMO 是否可能作为一种肺保护策略有益。
