EARLY EXPERIENCE WITH ADULT EXTRACORPOREAL MEMBRANE-OXYGENATION IN THE MODERN ERA
EARLY EXPERIENCE WITH ADULT EXTRACORPOREAL MEMBRANE-OXYGENATION IN THE MODERN ERA
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DOI：
10.1016/0003-4975(92)90311-q
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发表时间：
1992-04-01
影响因子：
4.6
通讯作者：
BARTLETT, RH
中科院分区：
文献类型：
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作者：
ANDERSON, HL;DELIUS, RE;BARTLETT, RH
1980年，我们停止了对成人使用体外膜肺氧合，因为在1973年至1979年间接受治疗的20名患者中只有1人存活。 1988年10月，我们重新采用成人体外生命支持（ECLS），并修改了方案，包括尽可能使用静脉-静脉通路，使用大型氧合器清除CO2，激活凝血时间为180 - 200秒，病例选择基于90%的死亡率（30%经肺分流）。 在19例转诊患者中，14例符合ECLS标准。 这14例孤立性呼吸衰竭患者中有3例在ECLS开始前死亡，1例患者拒绝ECLS并死亡。 10只动物置于ECLS 2至24天。 适应症为肺炎（3）、心脏手术后（2）和成人呼吸窘迫综合征（5）。 5人痊愈，5人死亡。 早期死亡原因为进行性肺损伤（3例）、出血（1例）和室性心律失常（1例）。 1例晚期死亡发生在3个月时，继发于与肝移植相关的腹腔内并发症。 总之，10例重度呼吸衰竭成人患者接受了体外生命支持治疗; 5例患者恢复了肺功能，其中4例存活并出院回家。 存活患者通常较年轻，在疾病过程的早期接受ECLS治疗，强调早期干预是成功结局的一个关键因素。
In 1980 we stopped using extracorporeal membrane oxygenation for adults because only 1 of 20 patients treated between 1973 and 1979 survived. In October 1988 we returned to adult extracorporeal life support (ECLS) with a modified protocol including venovenous access when possible, large oxygenators for CO2 clearance, activated clotting time of 180 to 200 seconds, and case selection based on 90% mortality (30% transpulmonary shunt). Of 19 patients referred, 14 met criteria for ECLS. Three of these 14 patients with isolated respiratory failure died before ECLS could be started, and 1 patient refused ECLS and died. Ten were placed on ECLS for 2 to 24 days. Indications were pneumonia (3), post-cardiac operation (2), and adult respiratory distress syndrome (5). Five recovered and 5 died. The cause of early death was progressive pulmonary injury (3), hemorrhage (1), and ventricular arrhythmia (1). One late death occurred at 3 months secondary to intraabdominal complications related to liver transplantation. In conclusion, 10 adult patients with severe respiratory failure were treated with extracorporeal life support; 5 patients recovered lung function and 4 of these patients survived and were discharged to home. Surviving patients were typically younger and were placed on ECLS early in their disease process, emphasizing that early intervention is one key factor to a successful outcome.