Thrombolysis and extracorporeal cardiopulmonary resuscitation for cardiac arrest due to pulmonary embolism:A case report

BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.

Near-fatal Panton-Valentine leukocidin-positive Staphylococcus aureus pneumonia,shock and complicated extracorporeal membrane oxygenation cannulation:A case report

BACKGROUND Panton-Valentine leukocidin(PVL)is an exotoxin secreted by Staphylococcus aureus(S.aureus),responsible for skin and soft tissue infections.As a cause of severe necrotising pneumonia,it is associated with a high mortality rate.A rare entity,the epidemiology of PVL S.aureus(PVL-SA)pneumonia as a complication of influenza coinfection,particularly in young adults,is incompletely understood.CASE SUMMARY An adolescent girl presented with haemoptysis and respiratory distress,deteriorated rapidly,with acute respiratory distress syndrome(ARDS)and profound shock requiring extensive,prolonged resuscitation,emergency critical care and venovenous extracorporeal membrane oxygenation(ECMO).Cardiac arrest and a rare complication of ECMO cannulation necessitated intra-procedure extracorporeal cardiopulmonary resuscitation,i.e.,venoarterial ECMO.Coordinated infectious disease,microbiology and Public Health England engagement identified causative agents as PVL-SA and influenza A/H3N2 from bronchial aspirates within hours.Despite further complications of critical illness,the patient made an excellent recovery with normal cognitive function.The coordinated approach of numerous multidisciplinary specialists,nursing staff,infection control,specialist cardiorespiratory support,hospital services,both adult and paediatric and Public Health are testimony to what can be achieved to save life against expectation,against the odds.The case serves as a reminder of the deadly nature of PVL-SA when associated with influenza and describes a rare complication of ECMO cannulation.CONCLUSION PVL-SA can cause severe ARDS and profound shock,with influenza infection.A timely coordinated multispecialty approach can be lifesaving.

Unexpected complication during extracorporeal membrane oxygenation support: Ventilator associated systemic air embolism

Systemic air embolism through a bronchovenous fistu-la(BVF) has been described in patients undergoing positive-pressure ventilation. However, no report has mentioned the potential risks of systemic air embolism through a BVF in patients undergoing extracorporeal membrane oxygenation(ECMO). Positive-pressure ventilation and ECMO support in patients with lung injury can increase the risk of systemic air embolism through a BVF. Increased alveolar pressure, decreased pulmonary venous pressure, and anticoagulation are thought to be the factors that contribute to this complication. Here, we present a case of systemic air embolism in a patient with ECMO and mechanical ventilator support.

Veno-Venous Extracorporeal Membrane Oxygenation for Acute Lung Injury after Surgery for Aortic Dissection: A Case Report

Acute respiratory failure after surgery for aortic dissection is a serious complication that has been associated with increased mortality and morbidity. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is reported as one of the treatments for this life-threatening complication. A 78-year-old male patient was admitted to our hospital for Stanford type A acute aortic dissection. He underwent emergency replacement of the ascending aorta, after which he developed acute lung injury. It was difficult to maintain oxygenation with a respirator mask. Therefore, VV-ECMO was initiated on postoperative day 1. The oxygenation gradually improved, and VV-ECMO was continued until postoperative day 13. On postoperative day 25, mechanical ventilation was withdrawn. The patient was discharged from the hospital on postoperative day 149. We report a case of successful treatment of acute lung injury with VV-ECMO initiated after surgery for aortic dissection. VV-ECMO can be considered as a treatment option for severe acute lung injury after surgery for aortic dissection.

Survival of a patient who received extracorporeal membrane oxygenation due to postoperative myocardial infarction: A case report

BACKGROUND Cardiac arrest after noncardiac surgery is a dangerous complication that may contribute to mortality.Because of the high mortality rate and many complications of cardiac arrest,it is very important to identify and correct a reversible etiology early.By reporting the treatment process of this case,we aimed to broaden the diagnosis and treatment of cardiac arrest after noncardiac surgery and describe how cardiopulmonary resuscitation using extracorporeal membrane oxygenation(ECMO)can improve a patient’s chance of survival.CASE SUMMARY A 69-year-old man visited our hospital complaining of low back pain on July 12,2021.Magnetic resonance imaging showed lumbar disc herniation.Two hours after lumbar disc herniation surgery,the patient developed cardiac arrest.Cardiopulmonary resuscitation was performed,and ECMO was started 60 min after the initiation of cardiopulmonary resuscitation.Regarding the etiology of early cardiac arrest after surgery,acute myocardial infarction and pulmonary embolism were considered first.Based on ultrasound evaluation,acute myocardial infarction appeared more likely.Coronary angiography confirmed occlusion of the left anterior descending branch,and coronary artery stenting was performed.Pulmonary artery angiography was performed to exclude pulmonary embolism.Due to heparinization during ECMO and coronary angiography,there was a large amount of oozing blood in the surgical incision.Therefore,heparinfree ECMO was performed in the early stage,and routine heparinized ECMO was performed after hemorrhage stabilization.Eventually,the patient was discharged and made a full neurologic recovery.CONCLUSION For early postoperative cardiac arrest,acute myocardial infarction should be considered first,and heparin should be used with caution.

Treatment of a patient with aconitine poisoning using veno-arterial membrane oxygenation:A case report

BACKGROUND Aconitine poisoning is highly prone to causing malignant arrhythmias.The elimination of aconitine from the body takes a considerable amount of time,and during this period,patients are at a significant risk of death due to malignant arrhythmias associated with aconitine poisoning.CASE SUMMARY A 30-year-old male patient was admitted due to accidental ingestion of aconitinecontaining drugs.Upon arrival at the emergency department,the patient intermittently experienced malignant arrhythmias including ventricular tachycardia,ventricular fibrillation,ventricular premature beats,and cardiac arrest.Emergency interventions such as cardiopulmonary resuscitation and defibrillation were promptly administered.Additionally,veno-arterial extracorporeal membrane oxygenation(VA-ECMO)therapy was initiated.Successful resuscitation was achieved before ECMO placement,but upon initiation of ECMO,the patient experienced recurrent malignant arrhythmias.ECMO was utilized to maintain hemodynamics and respiration,while continuous blood purification therapy for toxin clearance,mechanical ventilation,and hypothermic brain protection therapy were concurrently administered.On the third day of VA-ECMO support,the patient’s respiratory and hemodynamic status stabilized,with only frequent ventricular premature beats observed on electrocardiographic monitoring,and echocardiography indicated recovery of cardiac contractile function.On the fourth day,a significant reduction in toxin levels was observed,along with stable hemodynamic and respiratory functions.Following a successful pump-controlled retrograde trial occlusion test,ECMO assistance was terminated.The patient gradually improved postoperatively and achieved recovery.He was discharged 11 days later.CONCLUSION VA-ECMO can serve as a bridging resuscitation technique for patients with reversible malignant arrhythmias.

Extracorporeal cardiopulmonary resuscitation for adult cardiac arrest patients

Cardiac arrest is a major cause of unexpected death in developed countries, and patients with cardiac arrest generally have a poor prognosis. Despite the use of conventional cardiopulmonary resuscitation(CPR), few patients could achieve return of spontaneous circulation(ROSC). Even if ROSC was achieved, some patients showed re-arrest and many survivors were unable to fully resume their former lifestyles because of severe neurological deficits. Safar et al reported the effectiveness of emergency cardiopulmonary bypass in an animal model and discussed the possibility of employing cardiopulmonary bypass as a CPR method. Because of progress in medical engineering, the system of venoarterial extracorporeal membrane oxygenation(ECMO) became small and portable, and it became easy to perform circulatory support in cardiac arrest or shock patients. Extracorporeal cardiopulmonary resuscitation(ECPR) has been reported to be superior to conventional CPR in in-hospital cardiac arrest patients. Venoarterial ECMO is generally performed in emergency settings and it can be used to perform ECPR in patients with out-of-hospital cardiac arrest. Although there is no sufficient evidence to support the efficacy of ECPR in patients with out-of-hospital cardiac arrest, encouraging results have been obtained in small case series.

Extracorporeal Membrane Oxygenation Improving Survival and Alleviating Kidney Injury in a Swine Model of Cardiac Arrest Compared to Conventional Cardiopulmonary Resuscitation

Background： Acute kidney injury （AKI） frequently occurs in cardiopulmonary resuscitation patients. Studies comparing the effects of extracorporeal membrane oxygenation （ECMO） with conventional cardiopuhnonary resuscitation （CCPR） on AKI were rare. This study aimed to compare the effects of ECMO with those of CCPR on survival rate and AKI and explore the underlying mechanisms in a swine model of cardiac arrest （CA）. Methods： Sixteen male pigs were treated with ventricular fibrillation to establish CA model and then underwent CCPR （CCPR group, n = 8） or ECMO during cardiopulmonary resuscitation （ECPR group, n = 8）. The study endpoints were 6 h after return of spontaneous circulation （ROSC） or death. Serum and urine samples were collected at baseline and during the 6 h after ROSC. The biomarkers of AKI were detected by enzyme-linked immunosorbent assay. The apoptosis of renal tubular epithelial cells was discovered by transmission electron microscope （TEM） and terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Apoptosis-related genes were detected by immune-staining and Western blotting. Data were compared by Student＇s t-test. Results： All pigs in ECPR group were successfully resuscitated with a higher 6-h survival rate （8/8） compared to CCPR group （6/8）. The expressions ofAKl biomarkers including neutrophil gelatinase-associated lipocalin （NGAL）, tissue inhibitor ofmetalloproteinase2 （TIMP2）, insulin-like growth factor-binding protein 7 （IGFBP7）, liver fatty acid-binding protein （LFABP）, and kidney injury molecule l （Kim-1） were all increased along with the time after ROSC in both groups and lower in ECPR group compared with CCPR group. Especially, products of urinary T1MP and IGFBP levels （TIMP＊IGFBP） were significantly lower at ROSC4 （0.58 ± 0.10 ng^2/ml^2 vs. 1.18 ± 0.38 ng^2/ml^2, t = 4.33, P =0.003） and ROSC6 （1.79 ±0.45 ng2^/ml^2 vs. 3.00 ±0.44 ng^2/ml^2, t = 5.49, P 〈 0.001）; urinary LFABP was significantly lower at ROSC6 （0.74 ± 0.06 pg/ml vs. 0.85 4±0.11 pg/ml, t = 2.41, P = 0.033）; and urinary Kim-1 was significantly lower at ROSC4 （0.66 ± 0.09 pg/ml vs. 0.83 ± 0.06 pg/ml, t = 3.99, P = 0.002） and ROSC6 （0.73 ± 0.12 pg/ml vs. 0.89 ± 0.08 pg/ml, t = 2.82, P = 0.016）. Under light microscope and TEM, the morphological injures in renal tissues were found to be improved in ECPR group. Moreover, apoptosis was also alleviated in ECPR group. Conclusions： Compared with CCPR, ECMO improves survival rate and alleviates AKI in a swine model of CA. The mechanism of which might be via downregulating AKI biomarkers and apoptosis in kidney.

Mechanical circulatory support in lung transplantation: Cardiopulmonary bypass, extracorporeal life support, and ex-vivo lung perfusion

Lung transplant is the standard of care for patients with end-stage lung disease refractory to medical management. There is currently a critical organ shortage for lung transplantation with only 17% of offered organs being transplanted. Of those patients receiving a lung transplant, up to 25% will develop primary graft dysfunction, which is associated with an 8-fold increase in 30-d mortality. There are numerous mechanical lung assistance modalities that may be employed to help combat these challenges. We will discuss the use of mechanical lung assistance during lung transplantation, as a bridge to transplant, as a treatment for primary graft dysfunction, and finally as a means to remodel and evaluate organs deemed unsuitable for transplant, thus increasing the donor pool, improving survival to transplant, and improving overall patient survival.

Original article：Extracorporeal membrane oxygenation during double-lung transplantation： single center experience

Background For patients with end-stage lung diseases, lung transplantation is the final therapeutic option. Sequential double-lung transplantation is recognized as an established procedure to avoid cardiopulmonary bypass （CPB）. But some of the sequential double-lung transplantations require CPB support during the surgical procedure for various reasons. However, conventional CPB may increase the risk of bleeding and early allograft dysfunction. Extracorporeal membrane oxygenation （ECMO） is more advantageous than conventional CPB during the perioperative period of transplantation. Replacing traditional CPS with ECMO is promising for those patients needing cardiopulmonary support during a sequential double-lung transplantation procedure. This study aimed to summarize the preliminary experience of ECMO practice in lung transplantation.Methods Between November 2002 and October 2008, twelve patients with end-stage lung diseases undergoing sequential double-lung transplantation were subjected to ECMO during the surgical procedure. Eleven patients were prepared for the procedure via transverse thoracostomy （clamshell） and cannulated through the ascending aorta and right atrium for ECMO. The first patient who underwent bilateral thoracotomy for bilateral sequential lung transplantation required emergency ECMO via the femoral artery and vein during the second lung implantation. The Medtronic centrifugal pump and ECMO package （CBIV97R1, Medtronic, Inc., USA） were used for all of the patients. Results During ECMO, the blood flow rate was set between 1.8-2.0 L.m2.min-1 to keep hemodynamic and oxygen saturation stable; colloid oncotic pressure was maintained at more than 18 mmHg with albumin and hematocrit （HCT） kept at 28% or more. Two patients died early in this series and the other 10 patients were weaned from ECMO successfully. The duration of ECMO was 1.38-67.00 hours, and postoperative intubation was 10,5-67.0 hours. Conclusions As an established technique of cardiopulmonary support, ECMO is helpful to keep hemodynamics stable, while reducing risk factors such as ischemia-reperfusion injury, anticoagulation requirement and systemic inflammatory response for sequential double-lung transplantation compared with conventional CPB.

Extracorporeal Cardiopulmonary Resuscitation in Children of Asia Pacific： A Retrospective Analysis of Extracorporeal Life Support Organization Registry

Background： Recent advances in extracorporeal membrane oxygenation （ECMO） have led to increasing interest in its use during cardiopuhnonary resuscitation （CPR）. However, decisions regarding extracorporeal CPR （ECPR） in children are difficult as a result of limited studies, especially in Asia Pacific. The objective of this study was to investigate trends in survival and demographic details for children with ECPR in Asia Pacific recorded in the Extracorporeal Life Support Organization （ELSO） registry from 1999 to 2016 and identify the risk factors associated with in-hospital mortality. Methods： The data of children younger than 18 years of age who received ECPR over the past 18 years in Asia Pacific were retrospectively analyzed. The data were extracted from the ELSO registry and divided into two 9-year groups （Group 1 1999-2007 and Group 2： 2008-2016） to assess temporal changes using univariate analysis. Then, univariate and multiple logistic regression analyses were performed between survivors and nonsurvivors to identify factors independently associated with in-hospital mortality. Results： A total of 321 children were included in final analysis, with an overall survival rate of 50.8%. Although survival rates were similar between Group 1 and Group 2 （43.1% vs. 52.5%,χ^2= 1.67, P - 0.196）, the median age （1.7 [0.3, 19.2] months for Group 1 vs. 5.6 [0.8, 64.9] months for Group 2, t = 2.93, P = 0.003） and weight （3.7 [3.0, 11.5] kg for Group 1 vs. 6.0 [3.4, 20.3] kg for Group 2, t = -3.14, P 0.002） of children increased over time, while the proportion of congenital heart disease （75.9% for Group 1 vs. 57.8% for Group 2, χ^2=6.52, P 0.011 ） and cardiogenic shock （36.2% for Group 1 vs. 7.2% for Group 2, χ^2=36.59, P 〈 0.001 ） decreased. Patient conditions before ECMO were worse, while ECMO complications decreased across time periods, especially renal complications. Multiple logistic regress!on analysis of ECMO complications showed that disseminated intravascular coagulation （DIC）, myocardial stunning, and neurological complications were independently associated with increased odds of hospital mortality. Conclusions： The broader indications and decreased complication rates make EPCR to be applicated more and more extensive in children in Asia Pacific region. ECMO complications such as myocardial stunning are independently associated with decreased survival.

In-depth review of cardiopulmonary support in COVID-19 patients with heart failure

Coronavirus disease 2019 infection has spread worldwide and causing massive burden to our healthcare system.Recent studies show multiorgan involvement during infection,with direct insult to the heart.Worsening of the heart function serves as a predictor of an adverse outcome.This finding raises a particular concern in high risk population,such as those with history of preexisting heart failure with or without implantable device.Lower baseline and different clinical characteristic might raise some challenge in managing either exacerbation or new onset heart failure that might occur as a consequence of the infection.A close look of the inflammatory markers gives an invaluable clue in managing this condition.Rapid deterioration might occur anytime in this setting and the need of cardiopulmonary support seems inevitable.However,the use of cardiopulmonary support in this patient is not without risk.Severe inflammatory response triggered by the infection in combination with the preexisting condition of the worsening heart and implantable device might cause a hypercoagulability state that should not be overlooked.Moreover,careful selection and consideration have to be met before selecting cardiopulmonary support as a last resort due to limited resource and personnel.By knowing the nature of the disease,the interaction between the inflammatory response and different baseline profile in heart failure patient might help clinician to salvage and preserve the remaining function of the heart.

目标体温管理对体外心肺复苏患者神经功能结局和出院生存率影响的系统评价

目的系统评价目标体温管理对体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)患者神经功能结局和出院生存率的影响。方法计算机检索PubMed、Cochrane Library、Elsevier、Web of Science、Ovid、中国知网、万方、SinoMed、中华医学期刊全文数据库中关于目标体温管理对ECPR患者结局指标影响的文献,检索时限均从建库至2023年6月1日。严格按照纳入排除标准进行筛选,提取资料,评价文献质量,采用RevMan 5.3软件对纳入研究进行Meta分析。结果共纳入8篇研究,包括3687例ECPR患者。与非目标体温管理组比较,目标体温管理未能显著改善患者神经功能结局(OR=1.37,95%CI 0.89~2.13,P=0.16)和出院生存率(OR=0.98,95%CI 0.82~1.15,P=0.77),且两组出血、下肢缺血、肾损伤和感染等ECMO相关并发症发生率差异无统计学意义(OR=1.24,95%CI 0.91~1.68,P=0.17)。结论目标体温管理对ECPR患者的神经结局和出院生存率无显著改善作用,但不会加重ECMO相关并发症的发生。

河北省体外膜氧合开展情况调查分析

目的调查近5年河北省体外膜氧合(ECMO)开展情况。方法河北省医师协会体外生命支持委员会于2024年1月1日至1月20日通过电话随访本省各地委员及各医院中心负责人,收集近5年ECMO开展情况。结果近5年ECMO开展中心数由8个上升到31个,年例数由65例上升到489例,ECMO机器数量由28台增加到100台。2023年开展ECMO的科室共计47个,其中急诊ICU有18个,ICU有21个,心内科ICU有3个,呼吸ICU有2个,心外科有3个。近5年呼吸支持和循环支持患者的住院生存率有下降趋势,2022年最低,2023年较2022年有所升高,体外心肺复苏(ECPR)患者的生存率总体有升高趋势。2023年不同适应证成人ECMO患者生存率偏低,呼吸支持患者的住院生存率为41.7%、循环支持为36.4%、ECPR患者为17.9%。2023年11个地市共开展ECMO 489例,开展最多的城市为274例,开展最少的城市为11例,ECMO生存率最高的城市为51.7%,生存率最低的城市为9%。结论近5年来河北省ECMO技术开展中心数和例数均较前明显增多,但仍存在各地区发展不平衡,生存率较国际及国内水平偏低,有待进一步完善三级医疗ECMO救治网络,加强培训与质量控制,从而推动河北省ECMO技术发展。

心跳呼吸骤停患者体外膜肺氧合撤机后预后不良影响因素及列线图预测模型建立

目的探讨心跳呼吸骤停(CPA)患者体外膜肺氧合(ECMO)撤机后预后不良的影响因素,并构建列线图预测模型。方法回顾性选取本院2020年5月—2023年8月收治的189例CPA患者为研究对象,随机分为验证组(n=57)及建模组(n=132)。根据建模组CPA患者ECMO撤机28 d内预后情况的不同分为预后良好组(n=49,生存)和预后不良组(n=83,死亡)。采用多因素Logistic回归分析对CPA患者ECMO撤机后预后不良的影响因素进行分析;使用R4.3.1软件中rms程序包构建预测CPA患者ECMO撤机后预后不良的列线图模型;采用受试者工作特征(ROC)曲线、校准曲线、临床决策(DCA)曲线对列线图模型的预测区分度、一致性、临床应用价值进行评估。结果预后不良组CPA至ECMO治疗时间、血乳酸水平、联合连续性肾脏替代疗法(CRRT)的患者占比长于或高于预后良好组,住院时间短于预后良好组,差异有统计学意义(P<0.05)。CPA至ECMO的治疗时间长、血乳酸高以及联合CRRT为CPA患者ECMO撤机后预后不良的独立危险因素,住院时间长为保护因素(P<0.05)。建模组和验证组的曲线下面积分别为0.913和0.896,H-L拟合度检验中,建模组χ^(2)=9.511,P=0.301,验证组χ^(2)=8.105,P=0.423。列线图模型预测的高风险阈值为0.05~0.72时,临床应用价值较高。结论CPA至ECMO治疗时间长、血乳酸高、联合CRRT、住院时间短是CPA患者ECMO撤机后预后不良的影响因素,基于这4个因素构建的列线图模型具有较高的预测效能。

体外心肺复苏对院外心脏骤停患者神经功能结局影响的研究进展

对于院外心脏骤停患者,体外心肺复苏能提供更有效的治疗,为患者争取更多生存机会及更好的神经功能结局。本文将从院外心脏骤停体外心肺复苏后神经功能结局、影响神经功能结局的因素这两个方面进行论述。

心肺联合移植的体外循环管理经验

目的总结心肺联合移植体外循环管理的初步经验。方法回顾性分析2014年7月至2022年12月行原位心肺联合移植术病例资料。男4例,女1例,年龄22~37岁,体重46~60 kg。诊断均为重度肺动脉高压合并心肺功能衰竭,其中3例为艾森曼格综合征。结果供体心肺冷缺血时间225~420 min。转流总时间188~323 min,主动脉阻断时间108~219 min,体外循环辅助时间71~134 min,体外循环流量2.4~3.2 L/(m2·min),平均动脉压50~80 mmHg,术中均采用改良超滤,超滤液1500~2000 ml。4例顺利撤离体外循环,1例出现停机术后止血困难及常规药物治疗不佳的循环不稳,行床边联合应用体外膜氧合(ECMO)、主动脉内球囊反搏(IABP)和连续性肾脏替代疗法辅助治疗,ECMO辅助153 h后成功撤机。最终5例患者均存活出院。结论心肺联合移植的体外循环管理具有其特殊性。患者术后出现常规药物治疗无效的呼吸循环衰竭时,应积极尽早使用IABP或ECMO等机械循环辅助联合治疗。

ECMO结合心肺复苏机在心搏骤停患者中的应用效果

目的分析基于心肺复苏机给予心搏骤停患者体外膜肺氧合(ECMO)的作用。方法选取2021年1月至2022年12月河南省人民医院收治的100例心搏骤停患者,进行回顾性研究,根据治疗方式分组,对照组使用心肺复苏机(50例),观察组加用ECMO(50例)。对比抢救成功率、生命体征恢复时间、血气指标和脑功能分级。结果观察组抢救成功率高于对照组,生命体征(自主心跳、呼吸、循环和血压)恢复时间较对照组短(P<0.05);治疗后,患者中心静脉血氧饱和度和乳酸清除率上升,血乳酸水平较对照组低(P<0.05);两组脑功能分级差异有统计学意义(P<0.05)。结论ECMO结合心肺复苏机可提高心搏骤停患者抢救成功率,利于生命体征恢复,对血气指标和预后均有改善作用。

体外心肺复苏患者在ECMO支持期间发生院内获得性感染的危险因素分析

目的探究体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)患者在体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持期间发生院内获得性感染(hospital-acquired infections,HAI)的危险因素。方法回顾性分析南京医科大学第一附属医院体外生命支持中心ECPR患者83例,根据是否从体液中培养出明确的微生物将患者分为院内获得性感染组(HAI组,n=35)和非院内获得性感染组(nHAI组,n=48),比较其一般资料、实验室检查及预后,用逐步法多因素Logistic回归分析探索相关影响因素。结果83例ECPR患者HAI发生率为42.2%,秩和检验显示,HAI组ECMO置管时间[min:30.0(22.5,40.0)vs.23.5(16.5,30.0)]、总住院时间[d:15.0(10.5,25.5)vs.9.5(4.0,19.3)]、ICU住院时间[d:13.0(9.0,21.5)vs.7.0(3.8,13.0)]、ECMO支持时间[d:6.0(5.1,7.9)vs.5.0(3.2,6.7)]和有创机械通气(invasive mechanical ventilation,IMV)时间[d:11.0(7.0,13.0)vs.5.0(3.0,9.0)]均长于nHAI组(均P<0.05);卡方检验显示,HAI组28 d病死率(60.0%vs.37.5%,P=0.043)、气管切开率(25.7%vs.4.2%,P=0.011)均大于nHAI组;多因素逐步二元Logistic回归分析显示,IMV≥7 d与HAI独立相关(OR=5.016,95%CI 1.659~15.168,P=0.004)。结论ECPR患者ECMO支持过程中发生HAI可能与不良预后相关,HAI发生与IMV≥7 d独立相关。

体外生命支持技术在气管外科中的应用——单中心经验

目的 评价体外生命支持(ECLS)技术在危重气管外科术中应用的安全性和优越性。方法 通过单中心回顾性研究,收集了2000年1月至2020年12月在体外膜氧合(ECMO)或体外循环(ECC)支持下接受高危气管外科手术的患者数据。评估基线特征、住院并发症、ECLS管理、手术相关数据和死亡率。结果 数据收集期限内,共107例患者在手术过程中接受了ECMO或ECC支持,其中男性67例(62.6%),中位年龄为48.9岁(14~76岁),手术涉及气管肿瘤67例、气管狭窄23例、气管压迫9例和气管瘘8例。ECLS模式包含ECC(n=28,26.2%),改良ECC技术(n=19,17.8%),静脉-静脉ECMO(V-V ECMO,n=44,41.1%)或静脉-动脉ECMO(V-A ECMO,n=16,15.0%)。ECMO和改良ECC组采用无肝素(n=18,16.8%)或低剂量肝素(n=61,57.0%)辅助。ECC、改良ECC、V-V和V-A ECMO的中位辅助时间为49、67、144和118 min。分别有8例患者(7.5%)出现术中并发症(大出血、低氧、循环不稳定),23例患者(21.5%)出现术后并发症(吻合口瘘、肺不张、呼吸道感染和支气管胸膜瘘)。ECC组输血更多(14/28),但与其他组比较,在输血量上没有显著差异。全部患者围术期死亡率为6.5%(n=7)。结论 尽管ECLS技术较少用于胸外科手术,但在选择性的危重气道术中,ECC或ECMO提供充分的气体交换或稳定的血流动力学,其中ECMO在安全性和便捷性上更具优势。