Yeo Hye Ju, Cho Woo Hyun, Kim Dohyung
1 Department of Internal medicine, Medical Research Institute of Pusan National University, 2 Department of Thoracic and Cardiovascular Surgery, the Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea.
J Thorac Dis. 2016 Jan;8(1):37-42. doi: 10.3978/j.issn.2072-1439.2016.01.32.
A clinical trial of extracorporeal membrane oxygenation (ECMO) as an alternative ventilator tool is being performed as a new indication for ECMO. The purpose of this study was to evaluate the feasibility of awake ECMO to increase the success rate of weaning patients from ECMO and ventilator care during treatment of postoperative severe acute respiratory distress syndrome (ARDS).
We retrospectively analyzed the clinical reports of 10 patients who underwent awake ECMO due to postoperative ARDS between August 2012 and May 2015. We analyzed patient history, the partial arterial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio, and patient outcome.
Seven patients (70%) were weaned from ECMO without difficulty; one patient failed to maintain awake ECMO, was re-intubated after 2 days of awake ECMO, and was re-tried on awake ECMO after 4 days of ventilator care. We weaned that patient from ECMO 2 days later. We weaned a total of eight patients (80%) from awake ECMO. The ECMO duration of surviving patients was 9.13±2.2 days (range, 6-12 days), and mean ventilator use duration was 6.8±4.7 days (range, 2-16 days). Two cases failed awake ECMO and died due to disease aggravation.
Awake ECMO was a useful weaning strategy after severe postoperative ARDS, as it avoids long-duration use of mechanical ventilation. Additionally, it is possible for patients to breathe spontaneously, which might prevents respiratory muscle dystrophy.
正在进行一项将体外膜肺氧合（ECMO）作为替代通气工具的临床试验，这是ECMO的一项新适应症。本研究的目的是评估清醒ECMO在治疗术后严重急性呼吸窘迫综合征（ARDS）期间提高患者脱离ECMO和呼吸机支持成功率的可行性。
我们回顾性分析了2012年8月至2015年5月期间因术后ARDS接受清醒ECMO治疗的10例患者的临床报告。我们分析了患者病史、动脉血氧分压（PaO2）/吸入氧分数（FiO2）比值以及患者预后情况。
7例患者（70%）顺利脱离ECMO；1例患者无法维持清醒ECMO状态，在清醒ECMO 2天后重新插管，并在接受呼吸机支持4天后再次尝试清醒ECMO。2天后我们使该患者脱离了ECMO。我们总共使8例患者（80%）脱离了清醒ECMO。存活患者的ECMO持续时间为9.13±2.2天（范围6 - 12天），平均呼吸机使用时间为6.8±4.7天（范围2 - 16天）。2例患者清醒ECMO失败，因病情加重死亡。
清醒ECMO是术后严重ARDS后一种有用的撤机策略，因为它避免了长时间使用机械通气。此外，患者有可能自主呼吸，这可能预防呼吸肌萎缩。
