Kolla S, Lee W A, Hirschl R B, Bartlett R H
Department of Surgery, University of Michigan Medical Center, Ann Arbor, USA.
ASAIO J. 1996 Sep-Oct;42(5):M809-19. doi: 10.1097/00002480-199609000-00103.
The authors retrospectively reviewed their institution's experience with extracorporeal life support (ECLS) for adult cardiovascular failure to determine efficacy and further indications for its use. From 1985 to 1996, venoarterial ECLS was used in 27 adult patients. Indications for ECLS included post cardiotomy cardiac failure, primary myocardial failure, bridge to transplant, and emergency cardiopulmonary resuscitation. The average age was 38.7 +/- 2.7 years and duration of support was 164.0 +/- 26.8 hr. Overall cardiovascular recovery from ECLS was 44%, and hospital survival was 30%. Late deaths were due to multisystem organ failure. Best results were obtained in patients whose processes were reversible during a short duration of ECLS (< 91.6 +/- 33.3 hr. The worst results were obtained in post cardiotomy patients who underwent prolonged support with ECLS. Evaluation of physiologic parameters during the first 30-48 hr of support showed marked improvements from values before ECLS. Because of its relative ease of deployment and its rapid correction of acute physiologic derangements, ECLS can be used as a temporary means of support to determine extent and reversibility of organ dysfunction. Longer term support should include consideration of other mechanical assist devices. The authors no longer consider bridge to transplant an indication for ECLS due to relative donor unavailability.
作者回顾性分析了其所在机构使用体外生命支持（ECLS）治疗成人心血管衰竭的经验，以确定其疗效及进一步的使用指征。1985年至1996年期间，27例成年患者接受了静脉-动脉ECLS治疗。ECLS的指征包括心脏术后心力衰竭、原发性心肌衰竭、过渡到移植以及紧急心肺复苏。患者平均年龄为38.7±2.7岁，支持时间为164.0±26.8小时。总体而言，ECLS治疗后心血管功能恢复率为44%，住院生存率为30%。晚期死亡原因是多系统器官衰竭。在接受ECLS短期治疗（<91.6±33.3小时）且病情可逆的患者中取得了最佳效果。在接受ECLS长期支持的心脏术后患者中效果最差。对支持治疗最初30 - 48小时内生理参数的评估显示，与ECLS治疗前相比有显著改善。由于其相对易于部署且能迅速纠正急性生理紊乱，ECLS可作为一种临时支持手段，以确定器官功能障碍的程度和可逆性。长期支持应考虑其他机械辅助装置。由于相对难以获得供体，作者不再将过渡到移植视为ECLS的指征。
