静脉‑动脉体外膜肺氧合上机时机的探讨

Initiation timing of veno‑arterial extracorporeal membrane oxygenation

静脉-动脉体外膜肺氧合(VA-ECMO)是各种原因导致的难治性心源性休克危重患者的挽救性治疗手段,可暂时代替心肺功能、迅速改善低氧血症、提高全身氧供,同时清除二氧化碳。虽然国际体外生命支持组织(ELSO)指南针对VA-ECMO提出了明确的适应证标准,但是基于心源性休克患者的基础疾病异质性大,其上机时机的界定仍然比较模糊。本文拟从生理和病理生理学角度出发,讨论暴发性心肌炎、急性心肌梗死、急性肺栓塞、肺移植相关急性右心功能衰竭、新型冠状病毒肺炎相关心肌损伤等导致的心源性休克以及体外心肺复苏(ECPR)的上机时机,拟为临床医生的判断和抉择提出更多的参考意见。

Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is a salvage therapy for critical patients with refractory cardiogenic shock caused by various reasons.It can temporarily replace cardiopulmonary function,and rapidly improve hypoxemia,increase systemic oxygen content and remove carbon dioxide.Although the Extracorporeal Life Support Organization(ELSO)guideline proposed clear indication for VA-ECMO,the heterogeneity of cardiac pathogeny is large,so the clear timing of ECMO initiation is still vague.We discuss the timing of ECMO initiation for external cardiopulmonary resuscitation(ECPR)and cardiogenic shock which is caused by fulminant myocarditis,acute myocardial infarction,acute pulmonary embolism,acute right heart failure related to lung transplantation,corona virus disease 2019(COVID-19)-associated cardiovascular collapse.Also,we look forward to making more suggestions for clinicians′judgment and choice for VA-ECMO.