Experience with percutaneous venoarterial cardiopulmonary bypass for emergency circulatory support
Experience with percutaneous venoarterial cardiopulmonary bypass for emergency circulatory support
复制标题
DOI：
10.1097/01.ccm.0000053522.55711.e3
复制
发表时间：
2003-03-01
影响因子：
8.8
通讯作者：
Lindner, KH
中科院分区：
文献类型：
--
作者：
Schwarz, B;Mair, P;Lindner, KH
目的：机械循环支持可以维持对标准药物治疗无反应的心力衰竭患者的重要器官灌注。本研究的目的是报告因长期心源性休克或心肺骤停而接受急诊经皮静脉动脉心肺转流术的患者的并发症和生存率。设计：回顾性临床研究。共46例患者接受了静脉动脉体外循环，25例是因为心源性休克对药物治疗无反应，21例是因为心肺骤停对标准高级心脏生命支持无反应。46例患者中有41例（89%）建立了稳定的体外循环; 5例患者（11%）仅在手术切开后完成股动脉插管。共有28例患者脱离体外循环（25例心源性休克患者中的19例与21例心肺骤停患者中的9例，p = 0.03），13例患者长期存活（25例心源性休克患者中的10例与21例心肺骤停患者中的3例，p = 0.1）。在18名患者（39%）中发现了与使用心肺转流术直接相关的并发症，与股动脉插管相关的严重并发症是转流术相关发病率的最常见单一原因（8例患者，17%）结论：急诊经皮心肺转流术后的长期存活率令人鼓舞，患者有潜在的心循环疾病，可以立即进行纠正干预（血管成形术、手术、移植）。
Objective: Mechanical circulatory support can maintain vital organ perfusion in patients with cardiac failure unresponsive to standard pharmacologic treatment. The purpose of the current study was to report complication and survival rates in patients supported with emergency percutaneous venoarterial cardiopulmonary bypass because of prolonged cardiogenic shock or cardiopulmonary arrest.Design: Retrospective clinical study.Subjects: A total of 46 patients supported with venoarterial cardiopulmonary bypass, 25 because of cardiogenic shock unresponsive to pharmacologic therapy and 21 because of cardiopulmonary arrest unresponsive to standard advanced cardiac life support.Results: In 41 of the 46 patients (89%), stable extracorporeal circulation was established; in five patients (11%), femoral cannulation was accomplished only after a surgical cutdown. A total of 28 patients were weaned from cardiopulmonary bypass (19 of 25 patients with cardiogenic shock vs. 9 of 21 patients with cardiopulmonary arrest, p =.03), and 13 patients had long-term survival (10 of 25 patients with cardiogenic shock vs. 3 of 21 patients with cardiopulmonary arrest, p =.1). Complications directly related to the use of cardiopulmonary bypass were found in 18 patients (39%), major complications related to femoral cannulation being the most common single cause for bypass-associated morbidity (eight patients, 17%)Conclusions: Long-term survival rates after emergency percutaneous cardiopulmonary bypass are encouraging in patients with an underlying cardiocirculatory disease amenable to immediate corrective intervention (angioplasty, surgery, transplantation).