Schmidt F, Jack T, Sasse M, Kaussen T, Bertram H, Horke A, Seidemann K, Beerbaum P, Koeditz H
Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
Department of Cardiothoracic Surgery, Transplantation and Vascular Surgery, Medical School Hannover, Hannover, Germany.
Pediatr Cardiol. 2015 Dec;36(8):1647-56. doi: 10.1007/s00246-015-1211-8. Epub 2015 Jun 7.
In pediatric patients with acute refractory cardiogenic shock (CS), extracorporeal membrane oxygenation (ECMO) remains an established procedure to maintain adequate organ perfusion. In this context, ECMO can be used as a bridging procedure to recovery, VAD or transplantation. While being supported by ECMO, most centers tend to keep their patients well sedated and supported by invasive ventilation. This may be associated with an increased risk of therapy-related morbidity and mortality. In order to optimize clinical management in pediatric patients with ECMO therapy, we report our strategy of veno-arterial ECMO (VA-ECMO) in extubated awake and conscious patients. We therefore present data of six of our patients with CS, who were treated by ECMO being awake without continuous analgosedation and invasive ventilation. Of these six patients, four were <1 year and two >14 years of age. Median time on ECMO was 17.4 days (range 6.9-94.2 days). Median time extubated, while receiving ECMO support was 9.5 days. Mean time extubated was 78 % of the total time on ECMO. Three patients reached full recovery of cardiac function on "Awake-VA-ECMO," whereas the other three were successfully bridged to destination therapy (VAD, heart transplantation, withdrawal). Four out of our six patients are still alive. Complications related to ECMO therapy (i.e., severe bleeding, site infection or dislocation of cannulas) were not observed. We conclude that "Awake-VA-ECMO" in extubated, spontaneously breathing conscious pediatric patients is feasible and safe for the treatment of acute CS and can be used as a "bridging therapy" to recovery, VAD implantation or transplantation.
在患有急性难治性心源性休克（CS）的儿科患者中，体外膜肺氧合（ECMO）仍然是维持充足器官灌注的既定治疗手段。在此背景下，ECMO可作为通向康复、心室辅助装置（VAD）或移植的过渡治疗手段。在接受ECMO支持时，大多数中心倾向于让患者保持深度镇静并接受有创通气支持。这可能会增加与治疗相关的发病率和死亡率。为了优化接受ECMO治疗的儿科患者的临床管理，我们报告了我们在拔管后清醒且有意识的患者中采用静脉-动脉ECMO（VA-ECMO）的治疗策略。因此，我们展示了6例CS患者的数据，这些患者在清醒状态下接受ECMO治疗，未进行持续镇痛镇静和有创通气。这6例患者中，4例年龄小于1岁，2例年龄大于14岁。ECMO支持的中位时间为17.4天（范围6.9 - 94.2天）。接受ECMO支持时拔管的中位时间为9.5天。平均拔管时间占ECMO总时间的78%。3例患者在“清醒VA-ECMO”治疗下心脏功能完全恢复，而另外3例成功过渡到目标治疗（VAD、心脏移植、撤机）。我们6例患者中有4例仍然存活。未观察到与ECMO治疗相关的并发症（即严重出血
