Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital, New York City, New York, USA.
Pulm Circ. 2013 Apr;3(2):432-5. doi: 10.4103/2045-8932.113178.
Pulmonary arterial hypertension (PAH) is a disease with significant morbidity and mortality, particularly during an acute decompensation. We describe a single-center experience of three patients with severe Group 1 PAH, refractory to targeted medical therapy, in which an extubated, nonsedated, extracorporeal membrane oxygenation (ECMO) strategy with an upper-body configuration was used as a bridge to recovery or lung transplantation. All three patients were extubated within 24 hours of ECMO initiation. Two patients were successfully bridged to lung transplantation, and the other patient was optimized on targeted PAH therapy with subsequent recovery from an acute decompensation. The upper-body ECMO configuration allowed for daily physical therapy, including one patient, who would otherwise have been unsuitable for transplantation, ambulating over 850 meters daily. This series demonstrates the feasibility of using ECMO to bridge PAH patients to recovery or transplantation while avoiding the complications of immobility and invasive mechanical ventilation.
肺动脉高压（PAH）是一种具有显著发病率和死亡率的疾病，尤其是在急性失代偿期。我们描述了三例严重 1 组 PAH 患者的单中心经验，这些患者对靶向药物治疗有反应，采用非镇静、体外膜氧合（ECMO）策略，并采用上半身配置作为恢复或肺移植的桥梁。所有三名患者在 ECMO 启动后 24 小时内拔管。两名患者成功桥接至肺移植，另一名患者在接受针对 PAH 的靶向治疗后，急性失代偿得到优化，随后恢复。上半身 ECMO 配置允许每天进行物理治疗，包括一名否则不适合移植的患者，每天步行超过 850 米。本系列研究表明，使用 ECMO 桥接 PAH 患者以恢复或移植是可行的，同时避免了不活动和有创机械通气的并发症。
