From the Intensive Care Medicine Department, Vall d'Hebron University Hospital, Barcelona, Spain; and Shock, Organ Dysfunction, and Resuscitation Research Group, Department of Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.
ASAIO J. 2019 Nov/Dec;65(8):760-768. doi: 10.1097/MAT.0000000000000905.
Because of a severe dysregulation of the host response to infection, septic shock may induce a profound imbalance between oxygen consumption and delivery, which in some cases may be refractory to conventional support measures. In this setting, extracorporeal membrane oxygenation (ECMO) may help to restore this ratio. Indeed, in neonates and children, this technique is already established as a valid salvage therapy. In spite of the rapid growth in the use of ECMO in recent years, the evidence of its benefits in adult patients is weak, particularly in cases of refractory septic shock. Nevertheless, several case series have reported good outcomes in selected cases with specific management. Here we explore the links between sepsis and ECMO, starting with the basic biology underlying the two entities. We then review the published literature on the use of extracorporeal support in adult patients with septic shock and finally conclude with a review of the key points of management that can optimize the results after this critical situation.
由于宿主对感染的反应严重失调，感染性休克可能导致氧消耗和输送之间的严重失衡，在某些情况下，这种失衡可能对常规支持措施产生抵抗。在这种情况下，体外膜氧合 (ECMO) 可能有助于恢复这种比例。事实上，在新生儿和儿童中，这项技术已经被确立为一种有效的挽救治疗方法。尽管近年来 ECMO 的使用迅速增加，但在成年患者中，其益处的证据仍然很薄弱，特别是在难治性感染性休克的情况下。尽管如此，一些病例系列报告了在特定管理的情况下，选择病例的良好结果。在这里，我们探讨了败血症和 ECMO 之间的联系，首先从这两个实体的基础生物学开始。然后，我们回顾了关于体外支持在成人感染性休克患者中的应用的文献，最后对管理的关键点进行了回顾，这些关键点可以优化这一危急情况下的结果。
