Heiss K F, Clark R H, Cornish J D, Stovroff M, Ricketts R, Kesser K, Stonecash M
Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
J Pediatr Surg. 1995 Mar;30(3):416-9. doi: 10.1016/0022-3468(95)90045-4.
Acute respiratory failure (ARF) secondary to congenital diaphragmatic hernia (CDH), unresponsive to maximal medical management, has traditionally been treated with venoarterial (VA) extracorporeal membrane oxygenation (ECMO). Venovenous (VV) ECMO offers several benefits over VA ECMO including preserved pulmonary blood flow, preservation of the carotid artery, and pulsatile flow. However, use of the VV modality has not been widespread because of concerns of the cardiac instability during bypass, and because only one double-lumen (DL) catheter size is available in the United States. The authors hypothesize that VV ECMO is a safe and effective treatment for CDH, symptomatic at birth, and report a single institution experience of preferential VV use for CDH. Over an 18-month period, 14 patients with CDH were placed on ECMO after maximal medical management failed, including high-frequency ventilation and nitric oxide in some cases. Ability to place the 14 Fr DL catheter was the sole criteria for VA or VV selection. Nine patients were successfully placed on VV and 5 on VA; no VV patient required conversion to VA. The two groups of patients were similar with respect to degree of illness, birth weight, EGA, time on and age at start of ECMO. Overall survival for this series was 64%: 66% in the VV group and 60% in the VA group. Two patients in the VV group were found to have congenital heart disease incompatible with life, were withdrawn from therapy and allowed to die, and are listed as treatment failures. The authors conclude that CDH patients receive adequate oxygenation and show hemodynamic stability on VV ECMO.(ABSTRACT TRUNCATED AT 250 WORDS)
继发于先天性膈疝（CDH）的急性呼吸衰竭（ARF），在接受最大程度的药物治疗后无反应，传统上采用静脉-动脉（VA）体外膜肺氧合（ECMO）治疗。静脉-静脉（VV）ECMO相对于VA ECMO有几个优点，包括保留肺血流、保留颈动脉和搏动血流。然而，由于担心体外循环期间的心脏不稳定，以及在美国只有一种双腔（DL）导管尺寸可用，VV模式的使用并不广泛。作者推测，VV ECMO对于出生时即有症状的CDH是一种安全有效的治疗方法，并报告了一家机构优先使用VV治疗CDH的经验。在18个月的时间里，14例CDH患者在最大程度的药物治疗失败后接受了ECMO治疗，其中一些病例采用了高频通气和一氧化氮治疗。能否置入14 Fr DL导管是选择VA或VV的唯一标准。9例患者成功接受了VV治疗，5例接受了VA治疗；没有VV患者需要转为VA治疗。两组患者在疾病程度、出生体重、孕龄、ECMO开始时间和年龄方面相似。该系列的总体生存率为64%：VV组为66%，VA组为60%。VV组有2例患者被发现患有无法存活的先天性心脏病，退出治疗并任其死亡，被列为治疗失败病例。作者得出结论认为，CDH患者在接受VV ECMO治疗时能获得足够的氧合，且血流动力学稳定。（摘要截选至250词）
