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镰状细胞病紧急心脏手术的静脉-动脉体外膜肺氧合。

Venoarterial Extracorporeal Membrane Oxygenation in Sickle Cell Disease for Urgent Cardiac Surgery.

机构信息

Service d'Anesthésie-Réanimation Chirurgicale, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France; U955-IMRB, Equipe 03 "Stratégies pharmacologiques et thérapeutiques expérimentales des insuffisances cardiaques et coronaires," Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.

Service d'Anesthésie-Réanimation Chirurgicale, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France.

出版信息

Ann Thorac Surg. 2020 Mar;109(3):e161-e162. doi: 10.1016/j.athoracsur.2019.05.093. Epub 2019 Jul 27.

Abstract

Sickle cell disease (SCD) is among the most common genetic diseases, with a recent increase in life expectancy. Patients may therefore need similar surgical procedures as does the general population, including cardiac surgery. Cardiopulmonary bypass is a homeostasis challenge for SCD patients, with high risk of vasoocclusive crisis. In the most severe cases of cardiogenic shock, venoarterial extracorporeal membrane oxygenation (VA-ECMO) may be required, with prolonged exposure to extreme nonphysiological conditions. We report a case of postcardiotomy shock in an SCD patient successfully managed with VA-ECMO. This highlights that SCD should not be a counterindication to VA-ECMO, pending multidisciplinary management.

摘要

镰状细胞病 (SCD) 是最常见的遗传疾病之一,近年来患者的预期寿命有所延长。因此,他们可能需要与普通人群类似的手术,包括心脏手术。体外循环对 SCD 患者是一种体内平衡的挑战,发生血管阻塞性危象的风险很高。在心肌梗死性休克最严重的情况下,可能需要使用静脉-动脉体外膜肺氧合 (VA-ECMO),并长时间暴露于极端非生理条件下。我们报告了一例 SCD 患者心脏手术后休克成功接受 VA-ECMO 治疗的病例。这表明,在多学科管理的前提下,SCD 不应成为 VA-ECMO 的禁忌症。

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