Chilletti Roberto, Ihle Joshua, Butt Warwick
ECLS Program, Royal Childrens Hospital, Melbourne, Australia.
Intensive Care, Alfred Hospital, Melbourne, Australia.
Can J Cardiol. 2025 Apr;41(4):605-612. doi: 10.1016/j.cjca.2024.12.031. Epub 2024 Dec 31.
Although extracorporeal membrane oxygenation (ECMO) for circulatory support in patients with severe septic shock commenced in newborn infants and children in the late 1980s, ECMO has remained a controversial treatment for adults with refractory septic shock (RSS). This is fundamentally because of differences in the predominant hemodynamic response to sepsis. In newborn infants and very young children ventricular failure, low cardiac output syndrome (LCOS) is the major hemodynamic response whereas adolescents and adults mainly have vasoplegic shock. ECMO is a very effective treatment for cardiogenic shock even shock caused by sepsis, with a survival that has varied from 40% to 70%; vasoplegic shock, however, requires vasopressors rather than ECMO, and hence survival of these patients with ECMO was poor (< 20%). However, since the early 2000s, sepsis- induced cardiomyopathy (SCM) with ventricular failure (identical to LCOS in children) has been increasingly described in adults, and the occurrence of cardiogenic shock caused by septic shock is treatable with ECMO. In the last 6 years, increasing publications of series of adults with RSS and cardiogenic shock receiving ECMO and ∼70+% surviving has led to increased use of VA ECMO for RSS.
尽管体外膜肺氧合（ECMO）用于严重脓毒性休克患者的循环支持始于20世纪80年代末的新生儿和儿童，但ECMO对难治性脓毒性休克（RSS）成人患者仍是一种有争议的治疗方法。这从根本上是因为对脓毒症的主要血流动力学反应存在差异。在新生儿和非常年幼的儿童中，心室衰竭、低心排血量综合征（LCOS）是主要的血流动力学反应，而青少年和成人主要表现为血管麻痹性休克。ECMO对心源性休克甚至脓毒症引起的休克是一种非常有效的治疗方法，生存率在40%至70%之间；然而，血管麻痹性休克需要血管升压药而非ECMO，因此这些接受ECMO治疗的患者生存率很低（<20%）。然而，自21世纪初以来，成人中越来越多地描述了伴有心室衰竭的脓毒症诱导型心肌病（SCM）（与儿童的LCOS相同），并且脓毒性休克引起的心源性休克可用ECMO治疗。在过去6年中，越来越多关于接受ECMO治疗且生存率约70%以上的RSS和心源性休克成人系列的出版物，导致VA ECMO在RSS中的使用增加。
