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心脏术后体外膜肺氧合的应用——一项系统评价

The use of extracorporeal membrane oxygenation postcardiotomy-A systematic review.

作者信息

Harahwa Tinotenda, Chor Cheryl Yan Ting, Harky Amer

机构信息

School of Medicine, St George's, University of London, London, UK.

Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.

出版信息

J Card Surg. 2020 Aug;35(8):1941-1953. doi: 10.1111/jocs.14694. Epub 2020 Jun 29.

DOI:10.1111/jocs.14694
PMID:32598523
Abstract

OBJECTIVES

The use of extracorporeal membrane oxygenation (ECMO) in cardiac surgery has been established in cases of postcardiotomy cardiogenic shock, which is refractory to conventional therapy with inotropes and intra-aortic balloon pulsation support. We sought to examine the literature in a systematic review manner on the outcomes of using ECMO postcardiac surgery.

METHODS

A comprehensive electronic literature search was done to identify all the articles that have discussed the use of ECMO postcardiac surgery. The keywords and medical subject headings terms were used to identify the relevant articles. Studies have been screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

The identified studies have been summarized in each relevant section of this study. Cardiogenic shock postcardiac surgery can benefit from ECMO to varying degrees and the survival for this; otherwise, fatal condition has been shown to be improving through the use of ECMO. However, the decision and timing to initiate ECMO therapy remains selective and is dependent on a range of factors such as patient factor, clinician's judgment, meaning there is no consistent and solid ground regarding the timing of ECMO initiation.

CONCLUSION

Current evidence suggests that the circulatory support provided by ECMO improves survival rates for postcardiac surgery cardiogenic shock patients who are refractory to inotropic management, without such ECMO support patient mortality rates would be much greater.

摘要

目的

体外膜肺氧合(ECMO)在心脏手术中的应用已确立于心切开术后心源性休克的病例,这类休克对使用血管活性药物和主动脉内球囊反搏支持的传统治疗无效。我们试图以系统综述的方式研究心脏手术后使用ECMO的结果的文献。

方法

进行了全面的电子文献检索,以识别所有讨论心脏手术后使用ECMO的文章。使用关键词和医学主题词来识别相关文章。根据系统评价和Meta分析的首选报告项目指南对研究进行筛选。

结果

已识别的研究在本研究的每个相关部分进行了总结。心脏手术后的心源性休克可在不同程度上从ECMO中获益,其生存率;否则,已证明通过使用ECMO,致命状况正在改善。然而,启动ECMO治疗的决定和时机仍然具有选择性,并且取决于一系列因素,如患者因素、临床医生的判断,这意味着关于启动ECMO的时机没有一致和坚实的依据。

结论

目前的证据表明,ECMO提供的循环支持提高了对血管活性药物治疗无效的心脏手术后心源性休克患者的生存率,没有这种ECMO支持,患者死亡率会高得多。

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