体外膜肺氧合过程中离心泵失功的应急处理

Emergency treatment of centrifugal pump dysfunction in extracorporeal membrane oxygenation

目的总结体外膜肺氧合(ECMO)治疗过程中离心泵失功导致血流量快速下降的应急处理流程与相关思考。方法分析皖南医学院第一附属医院重症医学科2021年9月25日收治的1例重症支原体肺炎、重症病毒性肺炎、急性呼吸窘迫综合征(ARDS)的14岁男性患儿ECMO治疗过程。结果患儿在有创机械通气下氧合难以维持,肺实变进展严重,经评估后实施静脉-静脉ECMO(VV-ECMO),氧合得到改善。在VV-ECMO运行120 h后,突发血流量下降,转速3822 r/min,流量仅0.2 L/min,提高转速后流量无变化。而此前ECMO转速3530 r/min,流量可达3.4 L/min,且持续稳定。经快速排查后确定是离心泵失功,随后成功置换ECMO,置换后流量满意。结论目前大多ECMO中心并未对泵前后压力进行常规监测,临床对离心泵失功的判断缺乏可视化和量化的技术及指标,同时对其处理也缺乏相应的临床经验。本文总结该病例ECMO离心泵失功的排查及处理流程以提供参考及借鉴。

Objective To summarize the treatment process of rapid decrease in blood flow due to centrifugal pump dysfunction during extracorporeal membrane oxygenation(ECMO)and its related thinking.Methods On September 25,2021,the ECMO treatment of a 14-year-old boy with severe mycoplasma pneumonia,severe viral pneumonia and acute respiratory distress syndrome(ARDS)admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College was analyzed.Results Oxygenation of the child was difficult to maintain under invasive mechanical ventilation,and lung consolidation progressed seriously.After evaluation,venous-venous ECMO(VV-ECMO)was implemented,then oxygenation was improved.In the 120th hour after VV-ECMO establishment,the blood flow sudden decreased,the speed was 3822 r/min,while the flow was only 0.2 L/min,more over there was no change in the flow when the speed was increased.Before that,the ECMO speed was 3530 r/min,and the flow was up to 3.4 L/min and stable.After rapid screening,it was determined that the centrifugal pump was dysfunction.ECMO was successfully replaced and the flow was satisfactory.Conclusions At present,most ECMO centers do not routinely monitor the pressure before and after the pump.There is a lack of visual and quantitative techniques or indicators to judge the pump's function,and there is also a lack of corresponding clinical experience in treatment.This paper summarizes the investigation and treatment process of ECMO pump dysfunction of this case to provide reference.