Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany.
Cardiothoracic Anaesthesia and Intensive Care, Manchester Royal Infirmary, Central Manchester University Hospitals, NHS Foundation Trust; Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
Crit Care Resusc. 2017 Oct;19(Suppl 1):15-20.
Extracorporeal membrane oxygenation (ECMO) can be used as rescue intervention for cardiac and/or respiratory failure. High-risk adult patients with adult congenital heart disease (ACHD) may require pre- and post-operative ECMO support.
DESIGN, SETTING AND PARTICIPANTS: Retrospective data collection within a five-year time period from 2011 to 2016, at a single-centre study at a tertiary university hospital and regional unit for ACHD. Patients with ACHD in cardiogenic shock or failure to be separated from cardio-pulmonary bypass (CPB) were included.
Venoarterial (VA) ECMO.
Three patients had Ebstein anomaly and one patient had a double-outlet right ventricle transposition type and severe atrioventricular valve insufficiency. Three male patients and one female patient were aged ranging from 19 to 52 years. All received VA ECMO, two each with central or peripheral cannulation. The mean duration of ECMO support was 7 days (range, 3-13 days) and bleeding complications were the main complications observed, with a range of 12 to 104 blood products used. One patient required renal replacement therapy for acute kidney injury and also had leg ischaemia.
Two of four patients (50%) were successfully weaned off ECMO and survived to hospital discharge in this high-risk group of patients in severe heart failure. The patients are currently at 3 and 4 years follow-up, with improved mobility and exercise tolerance compared with pre-operatively.
ECMO is a promising temporary rescue intervention for patients with ACHD and cardiogenic shock. The extracorporeal cardiac support is a useful bridge to recovery.
体外膜肺氧合（ECMO）可用于治疗心源性和/或呼吸衰竭。患有成人先天性心脏病（ACHD）的高危成年患者可能需要在术前和术后进行 ECMO 支持。
设计、地点和参与者：在 2011 年至 2016 年的五年期间，在一家三级大学医院和成人先天性心脏病区域单位进行回顾性数据收集。纳入因心源性休克或无法从体外循环（CPB）中分离而接受治疗的 ACHD 患者。
静脉动脉（VA）ECMO。
3 例患者患有埃布斯坦畸形，1 例患者患有双出口右心室型和严重的房室瓣关闭不全。3 例男性患者和 1 例女性患者年龄在 19 至 52 岁之间。所有患者均接受 VA ECMO 治疗，2 例患者接受中心或外周插管。ECMO 支持的平均时间为 7 天（范围 3-13 天），观察到的主要并发症是出血并发症，使用了 12 至 104 个血制品。1 例患者因急性肾损伤需要肾脏替代治疗，也有腿部缺血。
4 例患者中有 2 例（50%）成功脱机并在该严重心力衰竭高危患者组中存活至出院。这些患者目前的随访时间为 3 年和 4 年，与术前相比，活动能力和运动耐量均有所改善。
ECMO 是 ACHD 合并心源性休克患者有前途的临时抢救干预措施。体外心脏支持是恢复的有用桥梁。
