BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that...BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%.Embolization in important organs caused by complications of left ventricular thrombosis(LVT)during VA-ECMO is also an important reason.Although the incidence of LVT during VA-ECMO is not high,the consequences of embolization are disastrous.CASE SUMMARY A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d.After excluding the diagnosis of coronary heart disease,we established a diagnosis of“clinically explosive myocarditis”.The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO,with heparin for anticoagulation.On day 4 of ECMO support,a left ventricular thro-mbus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography.Left ventricular decompression was performed and ECMO was successfully removed,but the patient eventually died of multiple cerebral embolism.CONCLUSION LVT with high mobility during VA-ECMO may cause embolism in important organs.Therefore,a"wait and see"strategy should be avoided.展开更多
BACKGROUND Venoarterial extracorporeal membrane oxygenation(VA-ECMO)offers hemodynamic support for patients undergoing high-risk percutaneous coronary interventions(PCIs).However,long-term outcomes associated with VA-...BACKGROUND Venoarterial extracorporeal membrane oxygenation(VA-ECMO)offers hemodynamic support for patients undergoing high-risk percutaneous coronary interventions(PCIs).However,long-term outcomes associated with VA-ECMO have not previously been studied.AIM To explore long-term outcomes in high-risk cases undergoing PCI supported by VA-ECMO.METHODS In the present observational cohort study,61 patients who received VA-ECMOsupported high-risk PCI between April 2012 and January 2020 at the Sixth Medical Center of Chinese People’s Liberation Army General Hospital were enrolled.The endpoint characteristics such as all-cause mortality,repeated cardiovascular diseases,and cardiac death were examined.RESULTS Among 61 patients,three failed stent implantation due to chronic total occlusions with severely calcified lesions.One patient showed VA-ECMO intolerance because of high left ventricular afterload.PCI was successfully performed in 57 patients(93.4%).The in-hospital mortality was 23.0%,and the overall survival was 45.9%,with a median follow-up period of 38.6(8.6-62.1)mo.CONCLUSION VA-ECMO can be used as a support in patients undergoing high-risk PCI as it is associated with favorable long-term patient survival.展开更多
Cardiogenic shock(CS)is a life-threatening syndrome characterized by peripheral hypoperfusion and organ dysfunction caused by primary heart disease.Venoarterial extracorporeal membrane oxygenation(VA-ECMO)is a tempora...Cardiogenic shock(CS)is a life-threatening syndrome characterized by peripheral hypoperfusion and organ dysfunction caused by primary heart disease.Venoarterial extracorporeal membrane oxygenation(VA-ECMO)is a temporary mechanical circulatory support device for CS,used in cases of profound shock,biventricular failure,respiratory failure,and cardiac arrest that require urgent maximal support.While VA-ECMO provides effective tissue perfusion and ensures oxygen supply to organs,it is also associated with severe complications,among which acute kidney injury(AKI)is one of the most common and serious.To date,no comprehensive review has been conducted on the pathophysiology,influencing factors,and treatment of AKI associated with VA-ECMO.This paper aims to elaborate on the pathophysiological mechanisms,influencing factors,and treatment options for AKI in patients with CS undergoing VA-ECMO,providing clinical and nursing references.展开更多
目的探讨超声心动图在静脉-动脉体外膜肺氧合(venoarterial extracorporeal membrane oxygenation,VA-ECMO)支持治疗中的应用价值。方法收集2018年6月至2020年2月于本院行VA-ECMO支持治疗的25例患者的超声心动图资料及临床相关资料,其...目的探讨超声心动图在静脉-动脉体外膜肺氧合(venoarterial extracorporeal membrane oxygenation,VA-ECMO)支持治疗中的应用价值。方法收集2018年6月至2020年2月于本院行VA-ECMO支持治疗的25例患者的超声心动图资料及临床相关资料,其中撤机成功组患者16例,撤机失败组患者9例。分别于建立前、撤机前、撤机后12h内行常规经胸超声心动图检查,测量并记录相关数据,进行对比分析,同时记录应用ECMO的并发症。结果撤机成功患者撤机前和撤机后左室射血分数(ejection fraction of left ventricle,LVEF)及主动脉速度时间积分(aortic velocity time integral,VTIAV)较建立前增加,差异有统计学意义(P<0.05);撤机失败患者撤机前和撤机后LVEF及VTIAV较建立前减低,差异有统计学意义(P<0.05);LVEF及VTIAV在撤机成功患者与撤机失败患者两两比较中,两项指标在建立前差异无统计学意义(P>0.05),在撤机前和撤机后差异均有统计学意义(P<0.05)。本研究中超声检测出的并发症主要有心包积液、血栓、血肿和下肢缺血。结论超声心动图在VA-ECMO支持治疗中对患者心功能监测、撤机时机选择、预后判断及发现并发症具有重要的临床应用价值。展开更多
基金Supported by Tianjin Health Science and Technology Project,No.ZC20147.
文摘BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%.Embolization in important organs caused by complications of left ventricular thrombosis(LVT)during VA-ECMO is also an important reason.Although the incidence of LVT during VA-ECMO is not high,the consequences of embolization are disastrous.CASE SUMMARY A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d.After excluding the diagnosis of coronary heart disease,we established a diagnosis of“clinically explosive myocarditis”.The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO,with heparin for anticoagulation.On day 4 of ECMO support,a left ventricular thro-mbus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography.Left ventricular decompression was performed and ECMO was successfully removed,but the patient eventually died of multiple cerebral embolism.CONCLUSION LVT with high mobility during VA-ECMO may cause embolism in important organs.Therefore,a"wait and see"strategy should be avoided.
文摘BACKGROUND Venoarterial extracorporeal membrane oxygenation(VA-ECMO)offers hemodynamic support for patients undergoing high-risk percutaneous coronary interventions(PCIs).However,long-term outcomes associated with VA-ECMO have not previously been studied.AIM To explore long-term outcomes in high-risk cases undergoing PCI supported by VA-ECMO.METHODS In the present observational cohort study,61 patients who received VA-ECMOsupported high-risk PCI between April 2012 and January 2020 at the Sixth Medical Center of Chinese People’s Liberation Army General Hospital were enrolled.The endpoint characteristics such as all-cause mortality,repeated cardiovascular diseases,and cardiac death were examined.RESULTS Among 61 patients,three failed stent implantation due to chronic total occlusions with severely calcified lesions.One patient showed VA-ECMO intolerance because of high left ventricular afterload.PCI was successfully performed in 57 patients(93.4%).The in-hospital mortality was 23.0%,and the overall survival was 45.9%,with a median follow-up period of 38.6(8.6-62.1)mo.CONCLUSION VA-ECMO can be used as a support in patients undergoing high-risk PCI as it is associated with favorable long-term patient survival.
文摘Cardiogenic shock(CS)is a life-threatening syndrome characterized by peripheral hypoperfusion and organ dysfunction caused by primary heart disease.Venoarterial extracorporeal membrane oxygenation(VA-ECMO)is a temporary mechanical circulatory support device for CS,used in cases of profound shock,biventricular failure,respiratory failure,and cardiac arrest that require urgent maximal support.While VA-ECMO provides effective tissue perfusion and ensures oxygen supply to organs,it is also associated with severe complications,among which acute kidney injury(AKI)is one of the most common and serious.To date,no comprehensive review has been conducted on the pathophysiology,influencing factors,and treatment of AKI associated with VA-ECMO.This paper aims to elaborate on the pathophysiological mechanisms,influencing factors,and treatment options for AKI in patients with CS undergoing VA-ECMO,providing clinical and nursing references.
文摘目的探讨超声心动图在静脉-动脉体外膜肺氧合(venoarterial extracorporeal membrane oxygenation,VA-ECMO)支持治疗中的应用价值。方法收集2018年6月至2020年2月于本院行VA-ECMO支持治疗的25例患者的超声心动图资料及临床相关资料,其中撤机成功组患者16例,撤机失败组患者9例。分别于建立前、撤机前、撤机后12h内行常规经胸超声心动图检查,测量并记录相关数据,进行对比分析,同时记录应用ECMO的并发症。结果撤机成功患者撤机前和撤机后左室射血分数(ejection fraction of left ventricle,LVEF)及主动脉速度时间积分(aortic velocity time integral,VTIAV)较建立前增加,差异有统计学意义(P<0.05);撤机失败患者撤机前和撤机后LVEF及VTIAV较建立前减低,差异有统计学意义(P<0.05);LVEF及VTIAV在撤机成功患者与撤机失败患者两两比较中,两项指标在建立前差异无统计学意义(P>0.05),在撤机前和撤机后差异均有统计学意义(P<0.05)。本研究中超声检测出的并发症主要有心包积液、血栓、血肿和下肢缺血。结论超声心动图在VA-ECMO支持治疗中对患者心功能监测、撤机时机选择、预后判断及发现并发症具有重要的临床应用价值。
文摘目的:体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)是治疗可逆性心肺衰竭危重患儿的一种体外生命支持策略,越来越多地被应用于心脏术后低心排血量患者。然而使用ECMO的患者病死率与ECMO并发症息息相关,特别是出血、血栓形成及感染等,ECMO相关医院内感染成为ECMO成功与否的挑战。本研究旨在探讨儿童心脏术后静脉-动脉ECMO(venoarterial-ECMO,VA-ECMO)相关医院内感染的发病率及其危险因素。方法:回顾性收集2015年7月至2021年3月中南大学湘雅二医院儿童心脏外科手术后行VA-ECMO治疗的患者资料,将其分为感染组和非感染组,比较两组患者的临床特点、VA-ECMO相关医院内感染影响因素、病原微生物种类及患者病死例数等。采用logistic回归分析心脏术后VA-ECMO相关医院内感染的独立危险因素。结果:38例患儿中,18例(47.4%)发生VA-ECMO相关医院内感染(感染组),包括7例血液感染和11例呼吸道感染,以革兰氏阴性菌感染为主(16株,88.9%),主要为鲍曼不动杆菌(6株)、肺炎克雷伯菌(3株)及嗜麦芽窄食单胞菌(3株)。与非感染组(20例)相比,感染组体外循环时间、心肌阻断时间及VA-ECMO辅助时间较长(均P<0.05)。多因素logistic回归分析显示:体外循环时间(OR=1.012,95%CI:1.002~1.022;P=0.021)是VA-ECMO相关医院内感染的独立危险因素。感染组的存活出院例数少于非感染组(1 vs 11,P<0.05)。结论:体外循环时间是儿童心脏术后VA-ECMO相关院内感染的独立危险因素,缩短体外循环的时间可能会降低患儿VA-ECMO相关院内感染的发生率。是否发生VA-ECMO相关院内感染影响患儿存活出院的例数。
