Department of Cardio-Thoracic Surgery, Heart & Vascular Center, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
Cardiac Intensive Care Unit, Johns Hopkins Hospital, Baltimore, Maryland.
Ann Thorac Surg. 2021 Jan;111(1):327-369. doi: 10.1016/j.athoracsur.2020.07.009. Epub 2020 Oct 6.
Post-cardiotomy extracorporeal life support (PC-ECLS) in adult patients has been used only rarely but recent data have shown a remarkable increase in its use, almost certainly due to improved technology, ease of management, growing familiarity with its capability and decreased costs. Trends in worldwide in-hospital survival, however, rather than improving, have shown a decline in some experiences, likely due to increased use in more complex, critically ill patients rather than to suboptimal management. Nevertheless, PC-ECLS is proving to be a valuable resource for temporary cardiocirculatory and respiratory support in patients who would otherwise most likely die. Because a comprehensive review of PC-ECLS might be of use for the practitioner, and possibly improve patient management in this setting, the authors have attempted to create a concise, comprehensive and relevant analysis of all aspects related to PC-ECLS, with a particular emphasis on indications, technique, management and avoidance of complications, appraisal of new approaches and ethics, education and training.
体外膜肺氧合（ECLS）在心外科手术后的应用非常少见，但最近的数据显示其应用显著增加，这几乎肯定是由于技术的改进、管理的便利性、对其功能的熟悉程度的提高以及成本的降低。然而，全球住院患者的存活率并没有提高，在某些情况下反而有所下降，这可能是由于在更复杂、更危重的患者中使用 ECLS 增加，而不是由于管理不当。尽管如此，ECLS 正被证明是一种有价值的资源，可用于暂时支持心循环和呼吸功能，否则这些患者很可能会死亡。由于全面回顾 ECLS 可能对从业者有用，并可能改善该环境下的患者管理，作者试图对与 ECLS 相关的所有方面进行简明、全面和相关的分析，特别强调适应证、技术、管理和并发症的预防、新方法的评估以及伦理学、教育和培训。
