ECMO救治术后致死性肺栓塞致心搏骤停患者——附5例报告

Extracorporeal membrane oxygenation as salvage therapy for cardiac arrest caused by acute massive pulmonary embolism in 5 postoperative patients

目的探讨应用体外膜肺氧合(ECMO)救治术后大面积肺栓塞(PE)致心搏骤停(CA)患者的临床应用效果。方法山东大学齐鲁医院重症医学科2019年至2020年收治5例术后大面积PE致CA的患者,采取本院心肺复苏(CPR)和ECMO救治流程对患者进行抢救,记录患者的一般特征、CA发生情况、ECMO前检查结果(包括乳酸、pH值、心电图、床旁经胸心脏超声)、ECMO上机后自主循环恢复(ROSC)时间,ECMO转运下行肺动脉CT血管成像(CTA),ECMO期间治疗情况以及患者预后情况[包括是否成功撤离ECMO、ECMO相关并发症。格拉斯哥-匹兹堡脑功能评分(CPC)和出院存活率]。结果5例患者的平均年龄为55.2岁、术后发生CA的平均时间为2.6d。床旁经胸心脏超声显示右心室均明显增大,右心室1左心室比值>1。肺动脉CTA显示均为双侧肺动脉栓塞。CA至ECMO启动时间平均87.8 min;ECMO应用时间平均5.2d。1例行局部溶栓和碎栓,1例放置下肢静脉滤器。4例患者成功撤离ECMO,1例放弃。3例患者发生并发症。预后方面。3例患者意识恢复正常。1例呈植物状态,1例脑死亡。最终存活4例(80%),死亡1例。结论ECMO救治术后大面积PE致CA患者的临床应用效果较好。

Objective To investigate the elinical effect of extracorporeal membrane oxygenation(ECMO)in the reseur of cardiac arrest(CA)caused by acule massive pulmonary embolism(PE)in postoperative patienls.Methods From 2019 to 2020.5 posloperative patients with CA caused by acute massive PE were rescued by using ECMO in the drpartment of critical care medicine of Qilu Hospital of Shandong University.The cardiopulmonary resuseitation(CPR)and ECMO prolocol were adopted in our hospital to rescue the patients.The data related to patients,general chararteristics,stalus of occurrence of CA.pre-ECMO data(such a lactic acid.pH value,electrocardiogram,berdside trans-thoraeic echocardiography),time for restoration of spontaneous circulation(ROSC)from ECMO initiation,pulmonary artery CT angiograph(CTA)carried out under ECMO applieation,therapeutic methods during ECMO,and outcome situations[including success or failure of ECMO evacuation,ECMO related complications,Glasgow Piltsburgh cerebral performance categories(CPC),and discharge survival rate].Results The average age of 5 patients was 55.2 years old,and the average time of orrurrence of CA after operation was 2.6 days.Bedside transthoracic ulrasound showed that the right ventricle was significantly enlarged,and the ratlio of right ventricle to left ventricle was>1.Pulmonary CT A showed bilateral pulmonary embolism.The average time from CA to the beginning of applying ECMO was 87.8 minules;the average application lime of ECMO was 5.2 days.Loral thrombolysis and crushing thrombus were performed in 1 rase,and lower extremily venous filer was placed in 1 case.Four patients successfully withdrew ECMO and 1 patient gave up.Complications oreurred in 3 patients.Recovery of normal consciousness occurred in 3 patients,one patient was in vegelative stale and one patient presented brain death.Finally.4 cases(80%)survived and 1 rase died.Conclusion The elinical effeet of ECMO in the rescue treatment of CA calused by fatal large massive PE in postoperative patients is relatively good.