体外膜式氧合在成人心脏病患者中的应用

Objective To explore the experience on venoarterial extracorporeal membrane oxygenation (ECMO) in adult patients with cardiac failure. Methods From February 2005 to June 2008, 45 patients (male 34, female 11) undergoing cardiogenic shock required temporary ECMO support. Average age was (49.0±14.1) years. Average body weight was (67.0±12.8) kg. Coronary heart disease occupied in 21 cases, valve disease occupied in 8 cases, and cardiomyopathy occupied in 7 cases. All the patients could be divided into 3 groups: post-cardiotomy (group 1, n=31), post-transplantation (group 2, n=5), decompensate of chronic heart failure (group 3, n=9). Fourteen patients need cardiac resuscitation before ECMO support. ECMO implantation was performed through the femoral vessels or axillary artery or through the right atrium and ascending aorta. Results Average support duration of ECMO was (126.7± 104.3) h. Twenty-seven patients could be successfully weaned from support (60.0%), additionally, 5 were bridged to heart transplantation. The in-hospital mortality was 42. 2% (19/45). Twenty-six patients (57.8%) could be successfully discharged. The discharge rate was 58. 1% in group 1,4/5 in group 2 and was 4/9 in group 3. Twelve patients were re-operated for hemostasia. Three patients need femoral arterial thrombectomy because of ischemia of lower extremity. Additional intra-aortic balloon pumps were used in 11 patients, with 6 patients successfully discharged. The mortality rate for patients with acute renal failure treated by continuous renal replacement therapy under ECMO support was obviously high (7/9). The dominant mode of death was multisystem organ failure (9/19). Conclusion Early indication, control of complications, and paying attention to the treatment after ECMO support could improve our results with increasing experience.

Extracorporeal membrane oxygenation for treatment of cardiorespiratory function failure in adult patients