Chou Heng-Wen, Chang Te-I, Wang Chih-Hsien, Chou Nai-Kuan, Chi Nai-Hsin, Huang Shu-Chien, Wu I-Hui, Chan Chih-Yang, Ponge Lee-Mei, Wang Ya-Chen, Chen Yih-Sharng
Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei - Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei - Taiwan.
Int J Artif Organs. 2016 Aug 19;39(6):288-93. doi: 10.5301/ijao.5000511. Epub 2016 Jul 20.
Extracorporeal membrane oxygenation (ECMO) has been proven effective in life support for patients with refractory cardiopulmonary failure. Deteriorating patients who have removed their first ECMO support and required second or more courses of ECMO support have rarely been discussed.
All the records of the patients who experienced at least 2 courses of ECMO during single admission were retrieved. Survival was defined as survival to discharge. Demographic data and clinical information were compared between survival and nonsurvival groups. There were 86 patients who received at least 2 courses of ECMO in the 20-year database, and 27 (31.3%) were <18 years old. Of them, 87.3% received 2 runs of ECMO, 10.4% 3 runs, and 2.3% 4 runs. Overall survival rate was 30.2%. The survival rate for patients with 2 runs of ECMO was 33.3% (25 out of 75), 11.1% (1 out of 9) for 3 runs, and 0% (0 out of 2) for 4 runs. Multivariate analysis revealed that only ARF with hemodialysis was the independent risk factor.
The decision to perform repeated ECMO implantation is a complex and difficult process. Despite the arguments debating the consumption of resources and increased complications, there are still nearly 1 out of 3 patients who will survive to discharge. More than 2 courses of ECMO may be carefully considered for further rescue.
体外膜肺氧合（ECMO）已被证明对难治性心肺衰竭患者的生命支持有效。对于那些撤除首次ECMO支持后病情恶化且需要第二次或更多次ECMO支持的患者，相关讨论较少。
检索了单次住院期间至少接受2次ECMO治疗的患者的所有记录。生存定义为存活至出院。比较了存活组和未存活组的人口统计学数据及临床信息。在20年的数据库中，有86例患者至少接受了2次ECMO治疗，其中27例（31.3%）年龄小于18岁。其中，87.3%的患者接受了2次ECMO治疗，10.4%接受了3次，2.3%接受了4次。总体生存率为30.2%。接受2次ECMO治疗的患者生存率为33.3%（75例中的25例），接受3次的为11.1%（9例中的1例），接受4次的为0%（2例中的0例）。多因素分析显示，只有合并血液透析的急性肾衰是独立危险因素。
决定再次植入ECMO是一个复杂且困难的过程。尽管存在关于资源消耗和并发症增加的争论，但仍有近三分之一的患者能存活至出院。对于进一步抢救可谨慎考虑超过2次的ECMO治疗。
