Balik Martin, Porizka Michal, Matousek Vojtech, Brestovansky Petr, Svobodova Eva, Flaksa Marek, Rulisek Jan, Mlejnsky Frantisek, Hodkova Gabriela, Grus Tomas, Vobruba Vaclav, Belohlavek Jan
1 Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
2 Perfusion Unit, Department of Cardiovascular Surgery, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
Perfusion. 2019 Apr;34(1_suppl):74-81. doi: 10.1177/0267659119830551.
Data on management of severe accidental hypothermia published from an established high-volume extracorporeal membrane oxygenation centre are scarce.
A total of 28 patients with intravesical temperature lower than 28°C on admission were either treated with veno-arterial extracorporeal membrane oxygenation or rewarmed conservatively.
A total of 10 patients rewarmed on veno-arterial extracorporeal membrane oxygenation (age: 37 ± 12.6 years) and 18 conservatively (age: 55.2 ± 11.2 years) were collected over a course of 5 years. The dominant cause was alcohol intoxication with exposure to cold (39%), 12 patients were resuscitated prior to admission. The admission temperature in the extracorporeal membrane oxygenation group (23.8 ± 2.6°C) was lower than in the non-extracorporeal membrane oxygenation group (26.0 ± 1.5°C, p = 0.01). The peripheral percutaneous veno-arterial extracorporeal membrane oxygenation was always cannulated in malignant arrhythmias causing refractory cardiac arrest. The typical extracorporeal membrane oxygenation blood flow was 3-4 L/minute and sweep gas flow 2 L/minute, the median extracorporeal membrane oxygenation duration was 48.3 (28.1-86.7) hours. The median rates of rewarming did not differ (0.41 (0.35-0.7)°C/hour in extracorporeal membrane oxygenation and 0.77 (0.54-0.98)°C/hour in non-extracorporeal membrane oxygenation, p = 0.46) as well as the admission arterial lactate, pH and potassium. Their development was not different between the groups except for higher pH between the third and ninth hour of rewarming in the extracorporeal membrane oxygenation group. The hospital mortality was 10% in the extracorporeal membrane oxygenation group and 11.1% in the non-extracorporeal membrane oxygenation group with the median last Glasgow Coma Scale 15 and Cerebral Performance Score 1.
Veno-arterial extracorporeal membrane oxygenation for severe hypothermia shows promising outcome data collected in an extracorporeal membrane oxygenation/extracorporeal cardiopulmonary resuscitation centre located in a European urban area. Except for presence of refractory cardiac arrest, the established hypothermia-related prognostic indicators did not differ between patients in need for extracorporeal membrane oxygenation and those rewarmed without extracorporeal membrane oxygenation.
来自一家成熟的高容量体外膜肺氧合中心发表的关于严重意外低温管理的数据很少。
共有28例入院时膀胱内温度低于28°C的患者，要么接受静脉 - 动脉体外膜肺氧合治疗，要么进行保守复温。
在5年的时间里，共收集了10例接受静脉 - 动脉体外膜肺氧合复温的患者（年龄：37±12.6岁）和18例保守复温的患者（年龄：55.2±11.2岁）。主要原因是酒精中毒并暴露于寒冷环境（39%），12例患者在入院前已进行复苏。体外膜肺氧合组的入院温度（23.8±2.6°C）低于非体外膜肺氧合组（26.0±1.5°C，p = 0.01）。对于导致难治性心脏骤停的恶性心律失常，总是采用外周经皮静脉 - 动脉体外膜肺氧合插管。典型的体外膜肺氧合血流为3 - 4升/分钟，扫气流量为2升/分钟，体外膜肺氧合的中位持续时间为48.3（28.1 - 86.7）小时。复温的中位速率没有差异（体外膜肺氧合组为0.41（0.35 - 0.7）°C/小时，非体外膜肺氧合组为0.77（0.54 - 0.98）°C/小时，p = 0.46），入院时的动脉乳酸、pH值和钾水平也无差异。除了体外膜肺氧合组在复温的第三至第九小时之间pH值较高外，两组之间这些指标的变化没有差异。体外膜肺氧合组的医院死亡率为10%，非体外膜肺氧合组为11.1%，末次格拉斯哥昏迷量表中位数为15，脑功能评分中位数为1。
在欧洲城市地区的一家体外膜肺氧合/体外心肺复苏中心收集的数据显示，静脉 - 动脉体外膜肺氧合治疗严重低温有良好的结果。除了存在难治性心脏骤停外，需要体外膜肺氧合的患者与未进行体外膜肺氧合而复温的患者之间，已确定的低温相关预后指标没有差异。
