Helwani Mohammad A, Lim Aaron
Washington University, Department of Anesthesiology, St. Louis, Missouri.
Virginia Commonwealth University, Richmond, Virginia, USA.
Curr Opin Anaesthesiol. 2023 Feb 1;36(1):45-49. doi: 10.1097/ACO.0000000000001206. Epub 2022 Nov 15.
To describe sepsis-induced cardiomyopathy. Discuss indications and current evidence of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) in setting of sepsis-induced cardiomyopathy.
Recent data suggests a survival benefit with the use of VA-ECMO in patients with septic shock complicated by septic-induced cardiomyopathy with severe left ventricular systolic dysfunction. VA-ECMO was associated with poor outcomes in adults with septic shock without severe systolic dysfunction. The evidence is generated from retrospective and meta-analysis of observational studies.
Sepsis-induced cardiomyopathy is an increasingly recognized entity characterized by reversible ventricular dysfunction in the setting of sepsis. When hypotension persists despite standard management of septic shock (e.g. adequate fluid resuscitation, vasopressors, inotropes) and there is evidence of severe cardiac systolic dysfunction and end-organ hypoperfusion, VA-ECMO should be considered as a bridge therapy to recovery. VA-ECMO should not be used for isolated vasodilatory septic shock without significant myocardial dysfunction.
描述脓毒症诱导的心肌病。讨论在脓毒症诱导的心肌病情况下使用静脉-动脉体外膜肺氧合（VA-ECMO）的指征和当前证据。
近期数据表明，对于合并严重左心室收缩功能障碍的脓毒症诱导的心肌病并发感染性休克患者，使用VA-ECMO可带来生存获益。在无严重收缩功能障碍的感染性休克成年患者中，VA-ECMO与不良结局相关。证据来自观察性研究的回顾性分析和荟萃分析。
脓毒症诱导的心肌病是一种越来越被认可的疾病，其特征是在脓毒症情况下出现可逆性心室功能障碍。当尽管对感染性休克进行了标准治疗（如充分的液体复苏、血管升压药、正性肌力药）但低血压仍持续存在，且有严重心脏收缩功能障碍和器官灌注不足的证据时，VA-ECMO应被视为恢复的桥接治疗。VA-ECMO不应用于无明显心肌功能障碍的单纯血管扩张性感染性休克。
