Perchinsky M J, Long W B, Hill J G, Parsons J A, Bennett J B
Department of Surgery, Legacy Emanuel Hospital, Portland, Oregon 97227, USA.
Am J Surg. 1995 May;169(5):488-91. doi: 10.1016/S0002-9610(99)80201-3.
Patients who have massive but potentially survivable injuries frequently die from complications of hypovolemia, hypoxemia, hypothermia, metabolic acidosis, and coagulopathy. Emergency cardiopulmonary bypass has been unsuccessful in preventing such deaths because it involves systemic anticoagulation that exacerbates coagulopathy.
A simplified extracorporeal cardiopulmonary life support (ECLS) system was assembled consisting of a centrifugal pump head, heat exchanger, membranous oxygenator, percutaneous cannulas, and heparin-bonded circuitry. The entire system has heparin-bonded surfaces. Patients were resuscitated with the system after femoral vein-femoral artery cannulation. ECLS was used to resuscitate massively injured patients who were deteriorating despite maximal conventional therapy.
While receiving maximal conventional therapy, 6 patients developed hypothermia, metabolic acidosis, and coagulopathy causing pulmonary hemorrhaging and hypoxemia from severe underlying lung injuries. ECLS with heparin-bonded circuitry provided cardiopulmonary support and rewarming while physicians addressed coagulopathies and surgical bleeding and assessed survivability. Three patients survived.
ECLS with heparin-bonded circuitry offers supplemental capability in the resuscitation and cardiopulmonary support of selected massively injured patients while their primary injuries are being evaluated and treated.
遭受严重但有可能存活的创伤的患者常常死于低血容量、低氧血症、体温过低、代谢性酸中毒和凝血病等并发症。紧急体外循环在预防此类死亡方面并不成功，因为它涉及全身抗凝，会加剧凝血病。
组装了一个简化的体外心肺生命支持（ECLS）系统，该系统由一个离心泵头、热交换器、膜式氧合器、经皮插管和肝素结合回路组成。整个系统都有肝素结合表面。在股静脉 - 股动脉插管后，使用该系统对患者进行复苏。ECLS用于抢救尽管接受了最大程度的传统治疗但仍在恶化的重伤患者。
在接受最大程度的传统治疗时，6名患者出现体温过低、代谢性酸中毒和凝血病，导致严重的潜在肺部损伤引起肺出血和低氧血症。带有肝素结合回路的ECLS在医生处理凝血病和手术出血并评估生存可能性时提供心肺支持和复温。3名患者存活。
带有肝素结合回路的ECLS在选定的重伤患者的复苏和心肺支持方面提供了补充能力，同时对他们的原发性损伤进行评估和治疗。
