Takagaki Masami, Yamaguchi Hiroki, Ikeda Naoko, Takeda Kaori, Kasai Fumihito, Yahagi Kiyotaka, Kanzaki Shunji, Mitsuyama Shinichi, Kadowaki Tasuku, Kotani Toru
Department of Cardiovascular Surgery, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo, 135-8577, Japan.
Department of Cardiology, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2019 Nov;67(11):982-986. doi: 10.1007/s11748-018-0990-2. Epub 2018 Aug 17.
We present the cases of eight patients (mean age 75 years; EuroSCORE II 17.0 ± 22.0) who underwent post-cardiotomy venovenous extracorporeal membrane oxygenation (ECMO) without heparinization due to serious bleeding. Three liver cirrhosis, two chronic hemodialysis, three redo sternotomy, and two urgent surgery cases were included. Respiratory ECMO Survival Prediction score was - 5.1 ± 4.2 (estimated survival rate: approximately 30%). Mean ECMO duration was 14 days with 9 circuit exchanges. Five patients were weaned from ECMO and three were discharged alive at 90 days (survival 37.5%). There was a case of pump-head thrombosis requiring urgent circuit exchange. All experienced bleeding complications without clinically apparent pulmonary thromboembolism. Disseminated Intravascular Coagulation scores (Pre 1.3 ± 0.8 vs. Post 3.8 ± 1.7; p < 0.05) significantly increased (N = 6). Post-cardiotomy ECMO without heparinization facilitated patient rescue at a reasonable survival rate. However, bleeding complications were still observed. More sophisticated management protocols are warranted.
我们报告了8例患者（平均年龄75岁；欧洲心脏手术风险评估系统II评分17.0±22.0）的病例，这些患者因严重出血在心脏手术后接受了无肝素化的静脉-静脉体外膜肺氧合（ECMO）治疗。其中包括3例肝硬化患者、2例慢性血液透析患者、3例再次开胸手术患者和2例急诊手术患者。呼吸ECMO生存预测评分为-5.1±4.2（估计生存率：约30%）。ECMO平均持续时间为14天，进行了9次管路更换。5例患者成功撤机，3例在90天时存活出院（生存率37.5%）。有1例发生泵头血栓形成，需要紧急更换管路。所有患者均出现出血并发症，但无明显临床肺血栓栓塞。弥散性血管内凝血评分（术前1.3±0.8 vs.术后3.8±1.7；p<0.05）显著升高（n=6）。无肝素化的心脏术后ECMO以合理的生存率促进了患者的救治。然而，仍观察到出血并发症。需要更完善的管理方案。
