Focus on veno-venous ECMO in adults with severe ARDS
Focus on veno-venous ECMO in adults with severe ARDS
复制标题
重点关注成人严重 ARDS 的静脉-静脉 ECMO
DOI：
10.1007/s00134-016-4398-0
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发表时间：
2016
影响因子：
38.9
通讯作者：
A. Combes
中科院分区：
文献类型：
--
作者：
L. Papazian;M. Herridge;A. Combes
静脉-静脉体外膜氧合（vvECMO）可改善氧合并促进二氧化碳（CO2）清除[1，2]。在最严重的ARDS形式中，ECMO迅速促进纠正气体交换中的严重紊乱并节省时间，这允许治疗肺损伤的原因。ECMO技术的最新进展提高了安全性并促进了其使用[3-5]。了解膜式氧合器的气体交换性能对于帮助急性呼吸衰竭患者选择最佳系统非常重要。在一项对317名使用4种不同ECMO系统的vvECMO患者进行的体内研究中，Lehle等人[6]表明CO2转移依赖于扫气流量和血流量，而O2转移仅在血流量高于3 L/min时依赖于血流量。尽管从未仔细评估，但已提出ECMO使用与继发于回路诱导的血小板活化和聚集的血小板减少症的发生之间的关联。在一项对100名接受vvECMO治疗急性呼吸衰竭的成人进行的回顾性队列研究中，Abrams等人[7]表明危重病的严重程度和插管时的血小板计数与严重血小板减少症的发生独立相关，而ECMO支持的持续时间则无关。一个国际专家组的立场文件[8]描述了组织项目并提供安全和熟练的ECMO治疗急性呼吸衰竭的最佳方法。他们鼓励在更好的评价之前限制ECMO的广泛使用
Veno-venous extracorporeal membrane oxygenation (vvECMO) improves oxygenation and promotes carbon dioxide (CO2) removal [1, 2]. In the most severe form of ARDS, ECMO rapidly facilitates the correction of severe derangement in gas exchange and saves time, which allows one to treat the cause of lung injury. Recent advances in ECMO technology have improved safety and promoted its use [3–5].Knowledge of the gas exchange performance of membrane oxygenators is important to help choose the optimal system for patients suffering from acute respiratory failure. In an in vivo study of 317 vvECMO patients supported with four different ECMO systems, Lehle et al.[6] showed that CO2 transfer was dependent on sweep gas flow and blood flow, while O2 transfer was only dependent on blood flow when it was above 3 L/min. The association between ECMO use and the development of thrombocytopenia secondary to circuit-induced platelet activation and aggregation has been suggested, although never carefully evaluated. In a retrospective cohort study of 100 adults who received vvECMO for acute respiratory failure, Abrams et al.[7] demonstrated that the severity of critical illness and platelet count at the time of cannulation were independently associated with the development of severe thrombocytopenia, while the duration of ECMO support was not. A position paper [8] from an international group of experts described the optimal approach to organizing programs and delivering safe and proficient ECMO for acute respiratory failure. They encouraged restraint in the widespread use of ECMO until a better appreciation