Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY.
University of Kansas Medical Center, Kansas City, KS.
J Cardiothorac Vasc Anesth. 2020 Oct;34(10):2776-2792. doi: 10.1053/j.jvca.2019.12.047. Epub 2020 Jan 8.
Venoarterial extracorporeal membrane oxygenation (ECMO) is a well-established technique to rescue patients experiencing cardiogenic shock. As a form of temporary mechanical circulatory support, venoarterial ECMO can be life-saving, but it is resource intensive and associated with substantial morbidity and mortality. Optimal clinical outcomes require specific expertise in the principles and nuances of ECMO physiology and management. Key considerations discussed in this review include hemodynamic assessment and goals; pharmacologic anticoagulation; ECMO weaning strategies; and the prevention, evaluation, and treatment of common complications.
静脉-动脉体外膜肺氧合(ECMO)是一种成熟的技术,可用于抢救心源性休克患者。作为一种临时机械循环支持方式,静脉-动脉 ECMO 可以救命,但需要大量资源,且相关并发症发病率和死亡率较高。要获得最佳临床效果,需要掌握 ECMO 生理学和管理方面的专业知识和细微差别。本文将重点讨论血流动力学评估和目标、药物抗凝、ECMO 脱机策略,以及常见并发症的预防、评估和治疗。