Weymann Alexander, Schmack Bastian, Sabashnikov Anton, Bowles Christopher T, Raake Philipp, Arif Rawa, Verch Markus, Tochtermann Ursula, Roggenbach Jens, Popov Aron Frederik, Simon Andre Ruediger, Karck Matthias, Ruhparwar Arjang
Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, UB9 6JH London, UK.
J Cardiothorac Surg. 2014 Mar 29;9:60. doi: 10.1186/1749-8090-9-60.
The purpose of this prospective study was to evaluate the effects and functional outcome of central extracorporeal life support (ECLS) with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure.
Between August 2010 and August 2013, 12 consecutive patients (2 female) with a mean age of 31.6 ± 15.1 years received central ECLS with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure. Underlying disease was acute cardiac decompensation due to dilated cardiomyopathy (n = 3, 25%), coronary artery disease with acute myocardial infarction (AMI) (n = 3, 25%), and acute myocarditis (n = 6, 50%). We routinely implemented ECLS by cannulating the ascending aorta, right atrium and inserting a left ventricular decompression cannula vent via the right superior pulmonary vein.
All patients were successfully bridged to either recovery (n = 3, 25%), long-term biventricular support (n = 6, 50%) or cardiac transplantation (n = 3, 25%). Seven patients (58.3%) were discharged after a mean hospital stay of 42 ± 11.9 days. The overall survival from ECLS implantation to the end of the study was 58.3%. The cumulative ICU stay was 23.1 ± 9.6 days. The length of support was 8.0 ± 4.3 days (range 3-17 days).
We strongly recommend left ventricular decompression in refractory cardiogenic shock and lung failure to avoid pulmonary edema, left heart distension and facilitate myocardial recovery.
这项前瞻性研究的目的是评估采用左心室减压的中心体外膜肺氧合（ECLS）治疗难治性心源性休克和肺衰竭的效果及功能转归。
2010年8月至2013年8月期间，12例连续患者（2例女性）接受了采用左心室减压的中心ECLS治疗难治性心源性休克和肺衰竭。这些患者的平均年龄为31.6±15.1岁。基础疾病包括扩张型心肌病导致的急性心脏失代偿（n = 3，25%）、冠状动脉疾病伴急性心肌梗死（AMI）（n = 3，25%）以及急性心肌炎（n = 6，50%）。我们常规通过将导管插入升主动脉、右心房并经右上肺静脉插入左心室减压导管来实施ECLS。
所有患者均成功过渡到恢复（n = 3，25%）、长期双心室支持（n = 6，50%）或心脏移植（n = 3，25%）。7例患者（58.3%）在平均住院42±11.9天后出院。从植入ECLS到研究结束的总体生存率为58.3%。ICU累计住院时间为23.1±9.6天。支持时间为8.0±4.3天（范围3 - 17天）。
我们强烈建议在难治性心源性休克和肺衰竭中采用左心室减压，以避免肺水肿、左心扩张并促进心肌恢复。
