Martucci Gennaro, Lo Re Vincenzina, Arcadipane Antonio
Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Via Tricomi 5, 90127, Palermo, Italy.
Neurology Service, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.
Neurol Sci. 2016 Jul;37(7):1133-6. doi: 10.1007/s10072-016-2515-z. Epub 2016 Feb 19.
Extracorporeal membrane oxygenation (ECMO) is a life-saving mechanical respiratory and/or circulatory support for potentially reversible severe heart or respiratory injury untreatable with conventional therapies. Thanks to the technical and management improvements the use of ECMO has increased dramatically in the last few years. Data in the literature show a progressive increase in the overall outcome. Considering the improving survival rate of patients on ECMO, and the catastrophic effect of neurological injuries in such patients, the topic of neurological damage during the ICU stay in ECMO is gaining importance. We present a case series of six neurological injuries that occurred in 1 year during the ECMO run or after the ECMO weaning. In each case the neurological complication had a dramatic effect: ranging from brain death to prolonged ICU stay and long term disability. This case series has an informative impact for the multidisciplinary teams treating ECMO patients because of its heterogeneity in pathogenesis and clinical manifestation: cerebral hemorrhage, ischemic stroke due to cerebral fat embolism, acute disseminated encephalomyelitis due to H1N1 Influenza. In our ECMO hub we started strict neurological monitoring involving intensivists, a neurologist and our radiology service, but neurological complications are still an insidious diagnosis and treatment. Considering several possible neurological injuries may help reduce delay in diagnosis and speed rehabilitation.
体外膜肺氧合（ECMO）是一种用于挽救生命的机械呼吸和/或循环支持手段，适用于传统疗法无法治疗的、潜在可逆的严重心脏或呼吸损伤。由于技术和管理方面的改进，ECMO的使用在过去几年中急剧增加。文献数据显示总体预后呈逐步改善趋势。鉴于接受ECMO治疗患者的生存率不断提高，以及此类患者中神经损伤的灾难性影响，在ECMO支持期间入住重症监护病房（ICU）时发生神经损伤这一话题正变得越来越重要。我们呈现了一个病例系列，包含在ECMO运行期间或ECMO撤机后1年内发生的6例神经损伤。在每例病例中，神经并发症都产生了显著影响：从脑死亡到ICU住院时间延长以及长期残疾。这个病例系列对于治疗ECMO患者的多学科团队具有参考价值，因为其发病机制和临床表现具有异质性：脑出血、脑脂肪栓塞导致的缺血性卒中、甲型H1N1流感导致的急性播散性脑脊髓炎。在我们的ECMO中心，我们启动了由重症监护医生、神经科医生和放射科共同参与的严格神经监测，但神经并发症仍然是一个难以诊断和治疗的问题。考虑到多种可能的神经损伤情况可能有助于减少诊断延误并加速康复。
