Pulmonary Protection from Left Ventricular Distension During Venoarterial Extracorporeal Membrane Oxygenation: Review and Management Algorithm.
Pulmonary Protection from Left Ventricular Distension During Venoarterial Extracorporeal Membrane Oxygenation: Review and Management Algorithm.
复制标题
静脉动脉体外膜氧合期间左心室扩张的肺保护：审查和管理算法。
DOI：
10.1007/s00408-023-00616-8
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发表时间：
2023
期刊：
影响因子：
5
通讯作者：
Jorde,UlrichP
中科院分区：
文献类型：
--
作者：
Saeed,Omar;Nunez,JoseI;Jorde,UlrichP
在过去的十年中，静脉动脉体外膜氧合(VA-ECMO)在成人难治性心源性休克中的应用呈指数增长。尽管VA-ECMO提供心肺支持，但它可以改变左心室(LV)负荷状况，导致左心室扩张，使肺容易充血，并促进心内血栓形成。这些情况可以通过药物和机械卸载来缓解，但在这种方法的最佳时机和方法上仍存在知识空白。本文综述了VA-ECMO的流行病学，描述了监测和减少左心室负荷的病理生理学和方法，并总结了研究左心室卸载和不良事件之间关系的当代研究。我们提供了一种在VA-ECMO期间实施LV卸载的简单方案，以提供肺保护和改善预后。
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adults for refractory cardiogenic shock has risen exponentially during the prior decade. Although VA-ECMO provides cardiopulmonary support, it can alter left ventricular (LV) loading conditions leading to LV distension, which makes the lungs susceptible to congestion and promotes intracardiac thrombosis. These conditions can be alleviated by pharmacologic and mechanical unloading, but gaps in knowledge remain on optimal timing and methods of this approach. This review provides an overview of the epidemiology of VA-ECMO, describes pathophysiology and methods for monitoring and reducing LV loading and summarizes contemporary studies examining the association between LV unloading and adverse events. We offer a simple protocol for implementing LV unloading during VA-ECMO to provide pulmonary protection and improve outcomes.