使用Impella左心室辅助装置联合体外膜肺氧合治疗暴发性心肌炎的恢复情况增强：病例系列
Enhanced recovery from fulminant myocarditis by treatment with the combined use of the Impella left ventricular assist device with extracorporeal membrane oxygenation: a case series.
作者信息
Nandate Hideyuki, Nishihara Tasuku, Nakata Yukihiro, Hamada Taisuke, Takasaki Yasushi, Yorozuya Toshihiro
机构信息
Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
出版信息
JA Clin Rep. 2022 Feb 27;8(1):15. doi: 10.1186/s40981-022-00502-x.
BACKGROUND
We experienced two adult cases of fulminant myocarditis with severe cardiogenic shock where Impella left ventricular assist device [left ventricle (LV)-Impella] was concomitantly used with venoarterial extracorporeal membrane oxygenation (V-A ECMO).
CASE PRESENTATION
A 67-year-old man and a 49-year-old man with fulminant myocarditis were transferred to our hospital with mechanical support of V-A ECMO and IABP. Impella 5.0 and Impella CP were implanted 21 h and 17 h after establishing V-A ECMO for each case. Within 1 week, the patients' LV function progressively improved. Then the Impellas were withdrawn after discontinuing V-A ECMO. They were discharged from the intensive care unit within the following 8 days.
CONCLUSIONS
The optimal introducing timing of LV-Impella is not currently precise. However, this case report suggests that the initiation of LV-Impella within at least 24 h after establishing V-A ECMO may be acceptable for the recovery of cardiac function.
背景
我们遇到了两例暴发性心肌炎合并严重心源性休克的成年病例，在这两例中，Impella左心室辅助装置（左心室 - Impella）与静脉 - 动脉体外膜肺氧合（V - A ECMO）联合使用。
病例介绍
一名67岁男性和一名49岁男性患有暴发性心肌炎，在V - A ECMO和主动脉内球囊反搏（IABP）的机械支持下被转送至我院。在为每例患者建立V - A ECMO后21小时和17小时分别植入了Impella 5.0和Impella CP。在1周内，患者的左心室功能逐渐改善。然后在停用V - A ECMO后撤出Impella。他们在接下来的8天内从重症监护病房出院。
结论
目前左心室 - Impella的最佳引入时机尚不准确。然而，本病例报告表明，在建立V - A ECMO后至少24小时内启动左心室 - Impella对于心脏功能的恢复可能是可以接受的。
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