Focardi Martina, Santori Francesco, Defraia Beatrice, Grifoni Rossella, Gori Valentina, Bianchi Ilenia, Bonizzoli Manuela, Lazzeri Chiara, Peris Adriano
Forensic Pathology Unit, AOU Careggi, Largo Brambilla 3, 50134 Florence, Italy.
Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
Diseases. 2024 Oct 7;12(10):245. doi: 10.3390/diseases12100245.
This study examines the results of autopsy examinations specifically aimed at documenting complications arising from the implantation phase and treatment with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with refractory cardiac arrest. ECMO and VA-ECMO in particular are life-saving interventions that, in the case of cardiac arrest, can temporarily replace cardiac pump function. VA-ECMO is, however, a very invasive procedure and is associated with early mechanical, haemorrhagic, and thrombotic events, infections, and late multi-organ dysfunction. This research aims to evaluate autoptic and histologic findings in patients on VA-ECMO support, providing clinical and forensic evaluation elements with respect to the procedure and clinical settings. The study analysed 10 cases, considering variables such as the duration of cardiac arrest, understood as the time between the cardiac arrest event and reperfusion with VA-ECMO, the duration of VA-ECMO support, and any complications detected by clinicians during treatment. The results highlighted the presence of numerous ischemic and haemorrhagic events affecting various organs. Among them, the intestines were particularly vulnerable, even after a short ECMO duration. : ECMO was found to accelerate post-mortem decomposition, affecting post-mortem interval estimations, and cardiac damage from reperfusion, underlining the need to meticulously select indications for treatment with VA-ECMO and perform constant clinical evaluations during the treatment itself.
本研究调查了尸检结果，这些尸检专门旨在记录难治性心脏骤停患者在植入阶段及接受静脉-动脉体外膜肺氧合（VA-ECMO）治疗时出现的并发症。ECMO尤其是VA-ECMO是挽救生命的干预措施，在心脏骤停的情况下，可暂时替代心脏泵功能。然而，VA-ECMO是一种侵入性很强的操作，与早期机械性、出血性和血栓形成事件、感染以及晚期多器官功能障碍相关。本研究旨在评估接受VA-ECMO支持的患者的尸检和组织学发现，提供有关该操作及临床情况的临床和法医学评估要素。该研究分析了10例病例，考虑了诸如心脏骤停持续时间（定义为心脏骤停事件与VA-ECMO再灌注之间的时间）、VA-ECMO支持持续时间以及临床医生在治疗期间检测到的任何并发症等变量。结果突出显示存在影响多个器官的大量缺血性和出血性事件。其中，即使在ECMO持续时间较短的情况下，肠道也特别脆弱。研究发现ECMO会加速死后尸体分解，影响死后间隔时间的估计，以及再灌注造成的心脏损伤，这突出表明需要精心选择VA-ECMO治疗的适应症，并在治疗过程中持续进行临床评估。
