单肺移植同期行肺减容术纠正移植肺容积不匹配

目的 探讨单肺移植同期行肺减容术纠正移植肺容积不匹配的有效性和安全性.方法 24例次单肺移植的受者中,男性20例,女性4例,年龄(54.6±12.2)岁(28～75岁).原发病为终末期慢性阻塞性肺疾病(COPD)14例,COPD合并上叶毁损肺1例,COPD合并尘肺1例,终末期肺间质纤维化6例,淋巴管血管平滑肌瘤病1例,肺移植术后闭塞性细支气管炎综合征1例.采用右侧单肺移植16例,左侧单肺移植8例.肺减容采用开胸手术,移植肺减容在移植同期的手术视野下操作,自体肺减容采用移植肺对侧的前外侧小切口进胸.术后将受者分为减容组和对照组.减容组有8例受者,其中移植肺减容5例,自体病肺减容2例,移植肺和自体肺共减容1例.将未接受肺减容术的16例受者作为对照组.观察和比较上述两组受者间肺功能等各项临床指标的差异.结果 原发病为COPD的受者中有2例接受了肺减容术,占14.3%(2/14),明显低于其他原发病者接受肺减容术的比例(60%,6/10),二者间差异有统计学意义(P＜0.05).减容组和对照组分别有50.0%和25%的受者术后胸部X线片显示纵隔位置居中,两组比较,差异有统计学意义(P＜0.05).两组间其余各项临床指标的比较,差异均无统计学意义(P＞0.05).但减容组受者的机械通气时间、胸管引流时间、漏气时间、胸管引流量都有增加的趋势,术后胸穿抽液次数和总量都有下降的趋势.有8例未行术后肺功能复查,其余16例次移植肺功能资料齐全,减容组4例,对照组12例,两组间术后第1秒用力呼气容积(FEV1)改善的差异无统计学意义(P＞0.05).结论 单肺移植同期行移植肺或自体肺减容术对纠正移植肺容积不匹配是安全、有效的方法,可以改善移植肺的通气血流比例.     

肺移植治疗肺弥漫性病变的疗效观察(附37例报告)

目的 观察肺移植治疗肺弥漫性病变的临床效果.方法 2002年9月至2009年4月,共对72例患者进行了肺移植,其中肺弥漫性病变患者37例.37例中,男性30例,女性7例,年龄(52.9±13.2)岁;原发病包括特发性肺间质纤维化30例,矽肺4例,肺淋巴管平滑肌瘤病2例,弥漫性泛细支气管炎1例.术前和术后常规监测肺功能,采用心脏超声检测肺动脉收缩压,并通过动脉血气分析计算氧合指数(氧分压/吸入氧浓度).观察和比较受者移植前后各项肺功能检测指标的变化.结果 术后1周,受者的肺动脉收缩压较术前有明显下降,从(54.30±17.41)mm Hg(1 mm Hg=0.133 kPa)降至(41.52±9.36)mm Hg(P＜0.05),氧合指数明显改善,从185.89±77.25上升至392.12±98.23(P＜0.05).术后1个月时,肺功能较术前明显改善,用力肺活量(FVC)由术前的(1.52±0.71)L上升至(2.26±0.64)L;第1秒用力呼气量(FEVl)由术前的(1.33±0.64)L上升至(1.81±0.57)L;一氧化碳弥散量由术前的(2.87±1.26)L上升至(4.22±2.05)L;各项检测值与术前比较,差异均有统计学意义(P＜0.05).结论 肺移植是治疗肺弥漫性病变的有效方法,可明显提高患者的存活率和生存质量.     

体外膜肺氧合在临床肺移植中的应用

目的 总结体外膜肺氧合(ECMO)技术在临床肺移植中应用的经验.方法 45例肺移植受者,年龄(50.5±8.6)岁(16～74)岁.原发病为肺纤维化合并肺动脉高压32例,慢性阻塞性肺病4例,矽肺2例,肺结核2例,弥漫性细支气管炎1例,支气管扩张2例,以及原发性肺动脉高压2例.其中3例受者在术前经股动、静脉切开置ECMO管道,分别维持13、19和6d后,在ECMO支持下接受了肺移植手术;40例受者在术中应用了ECMO辅助;2例未在体外循环下接受肺移植的受者,因原发性移植物功能丧失(PGD)于术后行ECMO辅助支持.结果 40例术中应用ECMO者,37例于术毕顺利撤除ECMO,术中辅助流量为(2.8±0.6)L/min,辅助持续时间为(7.7±0.9)h,存活31例;3例术后继续使用ECMO,直至血流动力学稳定,其中2例分别于术后36 h和7d时顺利撤除,另1例术后使用ECMO维持5d后出现急性肾功能衰竭,术后2周时死于多器官功能衰竭.2例术中无体外循环辅助受者和其余3例术中辅助受者因术后发生PGD或急性心力衰竭,而初次或再次使用ECMO,辅助流量分别为(2.5±0.3)L/min和(2.6±0.4)L/min,辅助持续时间分别为(53.5±21.9)h和(88.7±45.9)h,其中3例治愈出院,2例因多器官功能衰竭而死亡.所有受者均未发生明确与ECMO相关的并发症.结论 ECMO是肺移植围手术期支持的重要辅助工具,对于降低等待肺移植过程中的死亡率、稳定术中血流动力学、改善术后严重呼吸功能障碍以及原发性移植物功能不良,可以提供良好的辅助功能.     

肺移植治疗终末期肺疾病的单中心十年经验总结

目的 探讨肺移植治疗终末期肺疾病的效果,并对单中心肺移植的经验进行总结.方法 回顾2003年1月至2012年12月间52例肺移植病例的临床资料,受者年龄为24～76岁,≥65岁者13例;受者原发病主要为肺气肿33例(63.5％)及特发性肺间质纤维化8例(15.4％).术后对所有受者的并发症发生率、死亡情况及存活率进行分析.结果 供肺缺血时间＞6 h者28例(53.8％),其中缺血超过10 h者20例(38.5％).术后出现吻合口狭窄3例(5.8％),住院期间发生细菌感染14例(26.9％),真菌感染13例(25.0％),巨细胞病毒性肺炎1例(1.9％).发生急性排斥反应20例(38.5％),经甲泼尼龙冲击治疗3d后均逆转;发生慢性排斥反应7例(13.5％),其中2例接受再次肺移植后效果良好,3例调整免疫抑制方案后缓解,2例死亡.术后1年内死亡9例(17.3％),术后1、3和5年的总体累积存活率分别为81.4％,54.5％和30.9％.结论 肺移植是治疗终末期肺疾病的有效方法,恰当的病例选择、良好的肺保护、正确的围手术期处理及系统的术后管理是肺移植成功的关键.     

肺切除并肺减容术治疗肺癌及重度肺气肿

目的　总结 3例早、中期非小细胞肺癌合并重度肺气肿病人施行一侧肺切除并对侧肺减容术的治疗经验。方法　 3例男病人 ,年龄 6 0～ 6 4岁。鳞癌 2例 ,腺癌 1例。 2例癌肿位于右上肺叶 ,1例在左下肺叶。分期Ib 期 2例 ,IIa期 1例。术前气急分级 :2级 1例 ,3级 2例 ,第一秒用力呼气量(FEV1)平均 0 90L(36 3%预计值 )。动脉血氧分压 (PaO2 )平均 73 5mmHg(1mmHg =0 133kPa)。 6min行走平均 2 87 7m。肺癌行肺叶切除 2例、肺楔形切除 1例 ;同期切除对侧肺组织 (靶区 ) 2 0 %～ 30 %。结果　 3例病人术后恢复顺利。术后近期病人自觉症状如胸闷、气急等改善 ,气急指数均比原先上升 1级。随访 1～ 6个月FEV1较术前上升 0 40L ,PaO2 增加 2 0 5mmHg,6min行走增加增加 46 7% (平均 42 1m)。结论　对有选择的早中期肺癌合并重度肺气肿病例 ,同期施行肿瘤一侧肺切除及对侧肺减容术是适宜的治疗方法 ,从而扩大了肺癌的手术适应证。     

体外膜肺氧合在肺移植麻醉中的应用

目的 总结肺移植麻醉中体外膜肺氧合(extracorporeal memberane oxygenation,ECMO)辅助的适应证及术中运用ECMO支持的经验.方法 58例终末期肺病患者在麻醉诱导气管插管后,常规给予非术侧单肺通气30 min,监测肺动脉压(PAP)、氧分压(PaO2)、二氧化碳分压(PaCO2)、肺泡气·动脉氧分压差(PA-aO2)和呼吸力学等指标,根据监测指标调节机械通气参数,必要时行手控通气.17例患者分别因肺动脉高压、低氧血症和高碳酸血症而给予ECMO辅助,转流期间维持激活凝血时间(ACT)160秒～200秒,流量控制在1.8 L·m-2·min-1～2.5 L·m-2·min-1.结果 所有患者ECMO转流后PAP及PaCO:下降明显,氧合改善.麻醉伞程生命体征平稳.手术经过顺利.结论 ECMO是肺移植术中肺辅助的有效手段,可提高肺移植手术的麻醉成功率.原发性肺动脉高压、肺纤维化合并肺动脉高压、严重的低氧血症和高碳酸血症是肺移植术中ECMO转流的适应证.     

单肺移植术后受者对侧自体肺并发症的分析

目的 探讨单肺移植术后自体肺并发症对移植疗效和受者预后的影响.方法 回顾性分析自2003年1月至2012年8月间单中心施行的48例单肺移植的临床资料.患者的原发疾病分别为慢性阻塞性肺病29例(61％),特发性肺间质纤维化14例(29％),闭塞性细支气管炎2例(4％),尘肺2例(4％),肺淋巴管肌瘤1例(2％).分析术后对侧自体肺并发症发生情况及其预防和处理,并探讨其对受者预后的影响.结果 48例单肺移植受者中,21例(43.7％)出现了对侧自体肺并发症,其中7例(14.6％)因自体肺并发症死亡.并发症分别为气胸2例(4.2％),对侧肺减容术术后持续漏气1例(2.1％),后期自体肺过度膨胀4例(8.3％),顽固性乳糜胸1例(2.1％),肺内恶性肿瘤2例(4.2％),细菌感染6例(12.5％),真菌感染5例(10.4％).有自体肺并发症及无自体肺并发症受者术后1、3和5年存活率分别为63％、42％、21％以及85％、55％、48％ (P＜0.05).自体肺感染性并发症为影响预后的独立因子(P＜0.05).结论 受体对侧自体肺并发症是影响单肺移植预后的重要因素之一;非感染性的自体肺并发症,采用外科手段常可成功治疗,而自体肺感染的预后较差.     

结核毁损肺单侧全肺切除的麻醉处理

目的探讨结核毁损肺单侧全肺切除的麻醉处理. 方法 80例结核毁损肺行单侧全肺切除病人,术前肺功能减损轻度者30例(G组),中度者35例(M组),重度者15例(S组).56例行左侧全肺切除:44例使用双腔支气管导管(Carlon管10例、White管20例、左侧Robertshaw管8例、右侧Robertshaw管6例)、右单腔支气管导管7例、气管导管5例.24例行右侧全肺切除:21例使用双腔支气管导管(Carlon管19例、左侧Robertshaw管2例)、左单腔支气管导管2例、气管导管1例.痰量>50 ml/d的16例病人中,采用双腔支气管导管7例、右单腔支气管导管7例、左单腔支气管导管2例. 结果 G组、M组未发生围手术期并发症,S组术后发生急性呼吸衰竭5例(33.33%).痰量>50 ml/d的病人中,2例使用左单腔支气管导管的病人术后均发生健侧支气管病灶播散;而使用双腔支气管导管和右单腔支气管导管未发生结核播散. 结论结核毁损肺重度肺功能减损者,术前FEV1占预计值的百分比<35%,MVV占预计值的百分比<40%,行单侧全肺切除手术要慎重.术前痰量＞50 ml/d的病人,应选择双腔支气管导管或右单腔支气管导管,确保两肺分隔满意,以防止术后健侧支气管病灶播散.     

小儿胸膜肺母细胞瘤

目的探讨小儿胸膜肺母细胞瘤(PPB)的诊断、治疗及预后.方法回顾22例小儿胸膜肺母细胞瘤病例,按Dehuer病理分型为II型者15例、III型7例,对其进行随访.结果22例年龄3个月～10岁,男女比例1∶1.最早出现的症状均为咳嗽,发热19例,呼吸困难13例.早期X线表现肺囊性病4例,气胸1例,胸腔斑、片状影11例,胸腔积液4例,纵隔占位2例.来院前首诊(县、市级医院)误诊率100%,在我院首诊误诊率77.3%,首诊到确诊时间平均(5.4±6.2)个月.出现症状到确诊时间0.5～24个月.手术18例,术后均化疗.随访1个月～12年.生存9例,2年生存率27.3%,5年生存率9.1%.死亡13例,诊断到死亡时间1     

大鼠肺移植术后早期肺组织ICAM-1表达的变化

目的　研究大鼠肺移植术后早期肺组织细胞间粘附分子 1(ICAM 1)表达的变化。方法　用免疫组织化学 (SABC)法及设置内参照的半定量RT PCR方法 ,对移植肺获再灌注及通气 4h后肺组织的ICAM 1蛋白及其mRNA表达水平进行观察。实验组 (n =6 )肺经低钾右旋糖酐液 4℃保存12h后 ,行同种异体左肺原位移植。对照组 (n =6 )充分游离左侧肺动、静脉及支气管。免疫组织化学检测结果按阴性 (- )、可疑 (± )、弱阳性 ( )、阳性 ( )、强阳性 ( )进行记录。PCR产物电泳后扫描记录条带密度。结果　移植肺肺泡上皮及肺血管内皮细胞免疫着色显著较对照组深 (P<0 .0 1)。其ICAM 1mRNA与β actinmRNART PCR扩增产物相对密度值亦显著高于对照组 ,分别为 0 .873± 0 .0 44和 0 .44 2± 0 .0 37,P <0 .0 1。结论　肺移植术后早期肺组织ICAM 1表达上调 ,这种上调与ICAM 1mRNA增强有关。     

体外膜肺氧合在原发性及继发性肺动脉高压肺移植中的应用

目的 探讨体外膜肺氧合(ECMO)在肺移植围手术期应用的方法及疗效.方法 2005年11月至2009年7月,对30例原发性及终末期肺病伴继发性肺动脉高压的患者在肺移植术中应用了ECMO辅助,完成单肺移植18例,不横断胸骨序贯式双肺移植12例.2例患者在术前经股动静脉切开置ECMO管道,分别维持19 d和6 d,术中仍在ECMO支持下进行肺移植;其余患者在麻醉完成后置ECMO管道,开始肺移植术.移植完成后,受者在氧合和血流动力学平稳后撤除ECMO.结果 所有受者均顺利完成移植.27例受者于移植手术结束后顺利撤除ECMO;3例受者术后继续使用ECMO,直至血流动力学稳定,其中2例分别于术后36 h和7 d时顺利撤除,另1例术后用ECMO维持5 d后出现急性肾功能衰竭,术后2周时死于多器官功能衰竭.术后股动静脉切开处伤口感染2例,股动脉血栓形成(中度)1例,经治疗后均好转出院.结论 体外膜肺氧合可安全有效地应用于伴有原发性或继发性肺动脉高压患者的肺移植手术.术中应用ECMO能控制肺动脉高压,同时进行呼吸和循环支持,减少了肺移植手术的并发症.     

Successful provision of inter-hospital extracorporeal cardiopulmonary resuscitation for acute post-partum pulmonary embolism

Mortality during pregnancy in a well-resourced setting is rare, but acute pulmonary embolism is one of the leading causes. We present the successful use of extracorporeal cardiopulmonary resuscitation (eCPR) in a 22-year old woman who experienced cardiopulmonary collapse following urgent caesarean section in the setting of a sub-massive pulmonary embolus. Resources and personnel to perform eCPR were not available at the maternity hospital and were recruited from an adjacent pediatric hospital. Initial care used low blood flow extracorporeal membrane oxygenation (ECMO) with pediatric ECMO circuitry, which was optimized when the team from a nearby adult cardiac hospital arrived. Following ECMO support, the patient experienced massive hemorrhage which was managed with uterotonic agents, targeted transfusion, bilateral uterine artery embolisation and abdominal re-exploration. The patient was transferred to an adult unit where she remained on ECMO for five days. She was discharged home with normal cognitive function. This case highlights the role ECMO plays in providing extracorporeal respiratory or mechanical circulatory support in a high risk obstetric patient.     

体外膜肺氧合在肺移植围手术期的应用30例

目的 总结体外膜肺氧合(ECMO)在肺移植围手术期应用的经验.方法 30例原发性终末期肺病伴继发性肺动脉高压的患者在肺移植术中应用了ECMO,其中单肺移植18例,不横断胸骨序贯式双肺移植12例.在术前使用ECMO维持者2例,分别维持19 d和6 d;其他患者在麻醉完成后开始置ECMO管道.受者在氧合和血流动力学平稳后撒除ECMO.结果所有受者均顺利完成移植.27例于移植术后顺利撤除ECMO;3例术后继续使用ECMO,其中2例分别于术后36 h和7 d时顺利撤除,另1例未能撤除ECMO,术后5 d出现急性肾功能衰竭,术后2周时死于多器官功能衰竭.发生股动、静脉切口感染并发症者2例,股动脉血栓形成(中度)者1例,经治疗后均好转.结论 体外膜肺氧合可应用于伴有原发性或继发性肺动脉高压患者的肺移植手术,其并发症的发生可能与患者病情较重、血流动力学不稳定等因素有关,早期发现和积极有效地治疗可以改善患者的预后.

Abstract：

Objective To explore the perioperative application of extracorporeal membrane oxygenation (ECMO) in lung transplantation. Methods Thirty patients with primary and end-stage pulmonary disease accompanied by pulmonary hypertension were subjected to operation under the accessory of ECMO. Eighteen patients received single-lung transplantation and 12 patients bilateral sequential lung transplantation without sternal division in our hospital from November 2005 to July 2009. In 2 patients ECMO was given before operation and maintained for 19 days and 6 days respectively. In the remaining patients, ECMO pipeline was placed after anesthesia. After lung trarnsplantation,ECMO was removed after the recipients' oxygen saturation and hemodynamics were stable. Results In all recipients lung transplantation was successfully done. ECOM was removed in 27recipients after operation, and the rest 3 recipients were supported by ECMO after operation: the ECMO was removed at 36th h and 7th day after lung transplantation in two patients respectively,and another one was supported by ECMO for 5 days after operation and suffered acute kidney failure, and died of multiple organ failure 2 weeks post-transplantation. Two recipients were infected in thigh arteriovenous cut and one suffered femoral artery thrombosis, but all of them got better and discharged from hospital after treatment. Conclusion ECMO can be used for lung transplantation on patients with primary and secondary pulmonary hypertension. The complications may be associated with patients'serious condition and unstable hemodynamics. Early detection and active and effective treatment can improve patient's prognosis.     

小儿体外膜肺氧合支持治疗8例

目的 总结小儿先天性心脏病术后严重心力衰竭和暴发型心肌炎应用体外膜肺氧合(ECMO)支持治疗的经验.方法 8例中术后不能脱离CPB 7例、暴发型心肌炎1例.均使用离心泵,全部静脉-动脉模式;采用中心插管、右房-升主动脉7例,周围大血管插管、股静脉-股动脉模式1例.辅助65～498 h,辅助流量80～120ml·min-1·kg-1.结果 死亡5例;出院3例,生存率38%.并发症包括出血5例、血栓形成2例、溶血1例、DIC 1例、肝衰竭1例、营养不良2例、机械故障2例.结论 先心病术后无残余解削畸形,而出现严重心衰病例,往往因合并左、右心室并伴肺功能不全,宜及时施行ECMO支持治疗,而取代肺脏气体交换功能,减少呼吸器使用中的高浓度氧气和气道压的肺损伤,降低总体病死率;注意及时补充新鲜血小板、血浆等血制品;合理应用血管活性药物和肝素,根椐出血部位及量采用针对性措施,维持内环境稳定;加用超滤,减少机体特别是出血的并发症.应选用长期使用的肝素涂层膜肺,监测膜前后压力,注意血浆渗漏,减少机械并发症.

Abstract：

Objective The use of extracorporeal membrane oxygenation (ECMO) as a treatment for the failure of cardiopulmonary function after cardiac surgery is increasing and has been reported to be 3% to 5% in the cases with congenital heart disease. We reviewed our experience with ECMO in children who received heart surgery for congenital heart disease and complicated with severe heart failure postoperatively. Methods Eight patients received ECMO, seven was due to the failure to wean from bypass and one had fulminant myocarditis. Import membrane oxygenator,veno-arterial mode ECMO and right atriumascending aortic cannulation were used in 7 cases and peripheral cannulation via femoral veno-artery route was used in 1 case.Supportive intervention persisted from 65 to 498 hours, with flow rate maintained at 80 to 120 ml per minute per kilogram body weight. Results Five patients died, with a mortality of 62.5%, and 3 cases discharged, with a survival rate of 38%. Bleeding occurred in 5 cases, thrombosis occurred in 2 cases, hemolysis was identified in 1 case and DIC was observed in 1 case.One case had liver failure and 2 cases had malnutrition. Oxygenator plasma leakage occurred in 2 cases. Mean arterial blood pressure increased significantly after the establishment of ECMO as compared with that before the procedure [( 60.2 ± 7.8 )mmHg vs. (48. 1 ± 5.2 ) mmHg, P≤0.05]. The arterial concentration of lactate decreased significantly, from (5. 1 ± 0. 8 )mmol per liter before ECMO to ( 3.6 ±0. 5 )mmol per liter after ECMO, P ＜0.05. Conclusion For patients who survived the congenital heart surgery and no residual anatomic deformity, ECMO can be used as early as possible as a treatment for severe heart failure which resulted from coexistent of left and right ventricular and pulmonary insufficiency. An overall mortality may be decreased by ECMO technique as it plays a substitution role for gas exchange in the lung. As a result, the concentration of oxygen and the airway pressure used during ventilation, and the resultant lung injury can be reduced. Appropriate strategies involve transfusion of fresh platelet and packed red blood cells, replacement of frozen plasma and blood products, as well as rational use of vasoactive drugs and heparin, and maintaining a stable internal environment. Following strategies are also recommended: using continuous arterio-venous hemofiltration and durable heparin-coated membrne oxygenator, reducing hemorrhagic complications, monitoring pressure on both side of the film, identifying plasma leakage carefully and reducing the mechanical complications.     

Extracorporeal Membrane Oxygenation Can Save Lives in Children With Heart or Lung Failure After Liver Transplantation

The risk of cardiac or lung failure after liver transplantation (LT) is significant. In rare cases, the usual intensive care techniques fail to maintain organ oxygenation with a risk of multiorgan dysfunction. Although extracorporeal membrane oxygenation (ECMO) is a difficult and risky procedure, it can be proposed as life‐saving. Four children with either acute pulmonary (three) or cardiac (one) failure after LT, and the criteria that decided the use of ECMO (level of ventilation and results, dosage of inotropic drugs, cardiac ultrasound, blood lactate) were retrospectively reported. These patients, 1–11 years old, were treated with either veno‐arterial (three) or veno‐venous (one) ECMO. Two experienced a full recovery, with 3 and 6 years of follow‐up. Two died of systemic inflammatory response syndrome (SIRS) due to ECMO, and relapse of heart failure due to the underlying disease. Although our patients' survival was only 50%, we showed that ECMO can be useful in children after LT. It should be considered before the development of irreversible multiorgan failure.     

序贯式双肺移植九例报告

目的探讨9例序贯式双肺移植的手术指征和安全性。方法自2003年1月至2005年6月，共进行了9例序贯式双肺移植。2例受者在第1侧肺植入后恢复通气和灌注，再作第2侧肺的切除和植入；6例在第1侧肺植入后使用体外膜氧合（ECMO），再完成第2侧肺的切除和植入；1例在体外循环（CPB）下完成，同时使用一氧化氮（NO）吸入。结果前2例患者术中出现严重的移植肺水肿，术后仅生存12和36h。使用ECMO的6例患者均安全渡过手术关，术后移植肺氧合良好，拔除口插管时间为36～72h，平均为48h，其中4例患者顺利恢复出院，最长已生存16个月，1例术后1个月死于肺部感染大咯血，1例术后3周死于肾功能衰竭。使用CPB的1例患者术中死于大量渗血和严重的酸中毒。结论序贯式双肺移植手术指征较广，但手术风险大；使用ECMO可显著提高手术的安全性。     

Current Status of Extracorporeal Membrane Oxygenation for Severe Respiratory Failure

Abstract: Extracorporeal membrane oxygenation (ECMO) for respiratory failure was reviewed. ECMO progressed from laboratory research to initial clinical trials in 1972. Following a decade of clinical research, ECMO is now standard treatment for neonatal respiratory failure refractory to conventional pulmonary support techniques worldwide. The application of neonatal ECMO has been extended with improved outcome to premature and low birth weight infants as well as older children and adults. As of July 1994, 9,258 neonates, 754 pediatric, and 130 adult patients with respiratory failure treated with ECMO were entered in the registry of the Extracorporeal Life Support Organization (ELSO). Overall survival rates were 81% in neonates, 49% in pediatric, and 38% in adult patients. Recently the adult and pediatric populations treated with ECMO have increased rapidly, and the outcome has improved significantly.     

The early evaluation of survivors after extracorporeal membrane oxygenation for neonatal pulmonary failure

Excluding mortality data, there is little information regarding patients' development after extra corporeal membrane oxygenation (ECMO). In six of nine neonates surviving ECMO for predictably fatal pulmonary failure, examination 15 to 21 months afterward showed (1) physical growth and development, normal in six; (2) chest x-ray, normal pulmonary parenchyma; (3) average arterial blood gases, PO2 80, Pco2 35, pH 7.35; (4) echocardiogram, normal, without evidence of pulmonary hypertension; (5) cerebrovascular dopplers, normal ophthalmic artery flow in five patients, retrograde in one; (6) CT scan, EEG, neurologic survey, normal in five, cerebral atrophy in one patient who had an air embolus during decannulation; (7) psychologic examination, normal in all. This early evaluation of ECMO survivors should encourage its further application in those newborns who would otherwise die.