Spartera Marco, Jabbour Richard J, Chiarito Mauro, De Bonis Michele, Pappalardo Federico
Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy.
Imperial College London, London, UK.
Cardiovasc Revasc Med. 2017 Sep;18(6):447-449. doi: 10.1016/j.carrev.2017.04.001. Epub 2017 Apr 8.
This case describes the management of a patient admitted to an emergency department with general malaise, who deteriorated into cardiac arrest and refractory to advanced life support measures. After extracorporeal cardiopulmonary resuscitation (eCPR) with veno-arterial extracorporeal membrane oxygenation in association with an Impella 2.5 device, the patient underwent cardiac surgery (tissue aortic valve replacement, coronary artery bypass grafting and implantation of short-term paracorporeal left ventricular assist device). Subsequently a long-term LVAD was implanted and the patient was successfully discharged shortly afterwards. This report illustrates the challenges of 'clinical decision making' in a complex patient utilising a wide range of left ventricular support mechanical devices with varying degrees of invasiveness, whilst also reflecting on the current financial and economic considerations in utilizing this type of care pathway.
本病例描述了一名因全身不适入住急诊科的患者的治疗过程，该患者病情恶化至心脏骤停，且对高级生命支持措施无效。在使用静脉-动脉体外膜肺氧合联合Impella 2.5装置进行体外心肺复苏（eCPR）后，患者接受了心脏手术（组织主动脉瓣置换、冠状动脉旁路移植术以及短期体外左心室辅助装置植入）。随后植入了长期左心室辅助装置（LVAD），患者不久后成功出院。本报告阐述了在复杂患者中使用一系列具有不同侵入程度的左心室支持机械设备时“临床决策”面临的挑战，同时也反思了采用此类治疗途径时当前的财务和经济考量。
