Department of Cardiothoracic Surgery, Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, United Kingdom.
Department of Anaesthesia, Singapore General Hospital, Singapore, Singapore.
J Heart Lung Transplant. 2024 Feb;43(2):241-250. doi: 10.1016/j.healun.2023.09.008. Epub 2023 Sep 18.
Pulmonary endarterectomy (PEA) is the guideline-recommended treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, some patients develop severe cardiopulmonary compromise before surgery, intraoperatively, or early postoperatively. This may result from advanced CTEPH, reperfusion pulmonary edema, massive endobronchial bleeding, or right ventricular (RV) failure secondary to residual pulmonary hypertension. Conventional cardiorespiratory support is ineffective when these complications are severe. Since 2005, we used extracorporeal membrane oxygenation (ECMO) as a rescue therapy for this group. We review our experience with ECMO support in these patients.
This study was a retrospective analysis of patients who received perioperative ECMO for PEA from a single national center from August 2005 to July 2022. Data were prospectively collected.
One hundred and ten patients (4.7%) had extreme cardiorespiratory compromise requiring perioperative ECMO. Nine were established on ECMO before PEA. Of those who received ECMO postoperatively, 39 were for refractory reperfusion lung injury, 20 for RV failure, 31 for endobronchial bleeding, and the remaining 11 were for "other" reasons, such as cardiopulmonary resuscitation following late tamponade and aspiration pneumonitis. Sixty-two (56.4%) were successfully weaned from ECMO. Fifty-seven patients left the hospital alive, giving a salvage rate of 51.8%. Distal disease (Jamieson Type III) and significant residual pulmonary hypertension were also predictors of mortality on ECMO support. Overall, 5- and 10-year survival in patients who were discharged alive following ECMO support was 73.9% (SE: 6.1%) and 58.2% (SE: 9.5%), respectively.
Perioperative ECMO support has an appropriate role as rescue therapy for this group. Over 50% survived to hospital discharge. These patients had satisfactory longer-term survival.
肺动脉内膜剥脱术（PEA）是慢性血栓栓塞性肺动脉高压（CTEPH）患者的指南推荐治疗方法。然而，一些患者在手术前、手术中或手术后早期会出现严重的心肺功能衰竭。这可能是由于 CTEPH 晚期、再灌注肺水肿、大量支气管内出血或残余肺动脉高压引起的右心室（RV）衰竭引起的。当这些并发症严重时，常规心肺支持无效。自 2005 年以来，我们将体外膜氧合（ECMO）用作该组患者的抢救治疗。我们回顾了我们在这些患者中使用 ECMO 支持的经验。
本研究是对 2005 年 8 月至 2022 年 7 月期间，单一国家中心接受围手术期 ECMO 治疗 PEA 的患者进行的回顾性分析。数据是前瞻性收集的。
110 例（4.7%）患者出现严重心肺功能衰竭，需要围手术期 ECMO。其中 9 例在 PEA 前建立 ECMO。术后接受 ECMO 的患者中，39 例为难治性再灌注肺损伤，20 例为 RV 衰竭，31 例为支气管内出血，其余 11 例为“其他”原因，如晚期心脏压塞和吸入性肺炎后的心肺复苏。62 例（56.4%）成功撤离 ECMO。57 例患者存活出院，存活率为 51.8%。远端疾病（Jamieson Ⅲ型）和显著残余肺动脉高压也是 ECMO 支持时死亡的预测因素。总体而言，接受 ECMO 支持后存活出院的患者 5 年和 10 年生存率分别为 73.9%（SE：6.1%）和 58.2%（SE：9.5%）。
围手术期 ECMO 支持作为该组患者的抢救治疗具有适当的作用。超过 50%的患者存活出院。这些患者具有令人满意的长期生存率。
