Deschka Heinz, Machner Matthias, El Dsoki Salah, Alken Aiman, Wimmer-Greinecker Gerhard
Department for Cardiothoracic Surgery, Heart and Vessel Center Bad Bevensen, Bad Bevensen - Germany.
Int J Artif Organs. 2013 Oct;36(10):687-92. doi: 10.5301/ijao.5000233. Epub 2013 Aug 2.
Extracorporeal membrane oxygenation (ECMO) support is a widely accepted treatment option for patients with cardiogenic shock, but it is still related to a high incidence of severe complications and death. We present an alternative implantation technique to prevent life-threatening vascular complications.
Between January 2008 and January 2011, a total of 28 patients with acute myocardial failure and consecutive cardiogenic shock required ECMO as supportive treatment. Pre-implantation procedures were isolated CABG, CABG combined with mitral valve reconstruction or ventricular septal defect closure, respectively. The implantation of ECMO was performed by connecting the ascending aorta via an 8 mm Dacron prosthesis with the arterial line and percutaneous puncture of the femoral vein. The chest was closed after installation of ECMO was completed. The arterial line was directed subxyphoidally and removal was possible without thoracotomy.
Average support duration was 8.7 ± 3.9 days. An additional intra-aortic balloon pump was used in 23 patients (89.3%). Cerebrovascular events occurred in 21.4% and gastrointestinal complications in 9.1%. Acute renal failure was treated with continuous renal replacement therapy in 64.3%. In eight cases a systemic infection had to be treated. One patient with pre-existing severe peripheral arterial disease suffered from limb malperfusion, requiring leg amputation. Twelve patients were successfully weaned from ECMO and 8 patients (28.6%) were discharged from hospital.
This alternative cannulation strategy offers effective cardiopulmonary support while minimizing the risk of limb hypo- or hyperperfusion without requiring reopening of the thorax.
体外膜肺氧合（ECMO）支持是治疗心源性休克患者广泛接受的一种治疗选择，但它仍与严重并发症和死亡的高发生率相关。我们提出一种替代植入技术以预防危及生命的血管并发症。
在2008年1月至2011年1月期间，共有28例急性心肌衰竭并连续发生心源性休克的患者需要ECMO作为支持治疗。植入前的手术分别为单纯冠状动脉旁路移植术（CABG）、CABG联合二尖瓣重建或室间隔缺损修补术。通过8毫米涤纶人工血管将升主动脉与动脉管路相连，并经皮穿刺股静脉来进行ECMO植入。完成ECMO安装后关闭胸腔。动脉管路沿剑突下方向走行，无需开胸即可移除。
平均支持时间为8.7±3.9天。23例患者（89.3%）使用了主动脉内球囊反搏。脑血管事件发生率为21.4%，胃肠道并发症发生率为9.1%。64.3%的患者急性肾衰竭采用持续肾脏替代治疗。8例患者发生全身性感染需要治疗。1例原有严重外周动脉疾病的患者出现肢体灌注不良，需要截肢。12例患者成功脱离ECMO，8例患者（28.6%）出院。
这种替代插管策略可提供有效的心肺支持，同时将肢体灌注不足或过度灌注的风险降至最低，且无需再次开胸。
