Zobel G, Kuttnig-Haim M, Decar D, Urlesberger B, Riccabona M, Reiterer F, Maurer U, Friehs I, Berger J, Trop M
ECMO-Team Graz, Universität Graz.
Wien Klin Wochenschr. 1995;107(14):427-35.
The purpose of this report is to describe our experience with veno-arterial (VA) and veno-venous extracorporeal membrane oxygenation (VV-ECMO) for neonates and children with severe acute respiratory or cardiocirculatory failure. From 1990 to 1994 20 neonates and 12 children were treated at the ECMO center in Graz. Indications for ECMO were acute respiratory failure in 27 patients and cardiocirculatory failure in 5 patients. Mean duration of ECMO was 228 +/- 30 hours. Fifteen neonates were weaned from ECMO and were subsequently extubated. Of the 12 children 7 had severe acute respiratory failure and underwent VV-ECMO. Five of these 7 children were weaned from ECMO and subsequently extubated. Only two of 5 patients with cardiac ECMO support could be weaned from bypass; one patient subsequently died, but the other patient is a long-term survivor. All patients with cardiac ECMO support after open heart surgery had severe mediastinal bleeding. The survival rate in neonates and pediatric patients with respiratory failure treated by ECMO was 75% and 71%, respectively, whereas it was only 20% in children with cardiocirculatory failure. Major complications on ECMO were local and intracerebral bleeding. ECMO is an effective therapy for neonates and children with acute respiratory failure. It is less effective for cardiac support in children after open heart surgery, but the use of heparin-layered ECMO systems might increase the safety of the procedure.
本报告旨在描述我们使用静脉 - 动脉（VA）和静脉 - 静脉体外膜肺氧合（VV - ECMO）治疗患有严重急性呼吸或心肺循环衰竭的新生儿和儿童的经验。1990年至1994年期间，格拉茨的ECMO中心对20名新生儿和12名儿童进行了治疗。ECMO的适应症为27例急性呼吸衰竭和5例心肺循环衰竭。ECMO的平均持续时间为228±30小时。15名新生儿成功撤离ECMO并随后拔管。12名儿童中，7名患有严重急性呼吸衰竭并接受了VV - ECMO治疗。这7名儿童中有5名成功撤离ECMO并随后拔管。在接受心脏ECMO支持的5例患者中，只有2例能够脱离体外循环；1例患者随后死亡，另1例患者长期存活。所有接受心脏手术后心脏ECMO支持的患者均有严重纵隔出血。接受ECMO治疗的呼吸衰竭新生儿和儿科患者的存活率分别为75%和71%，而心肺循环衰竭儿童的存活率仅为20%。ECMO的主要并发症是局部和颅内出血。ECMO是治疗患有急性呼吸衰竭的新生儿和儿童的有效疗法。对于心脏手术后儿童的心脏支持效果较差，但使用肝素涂层的ECMO系统可能会提高该手术的安全性。
