Postcardiotomy Extracorporeal Life Support in Adults: The Optimal Duration of Bridging to Recovery
Postcardiotomy Extracorporeal Life Support in Adults: The Optimal Duration of Bridging to Recovery
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DOI：
10.1097/mat.0b013e3181b899c0
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发表时间：
2009-11-01
期刊：
影响因子：
4.2
通讯作者：
Liu, Kuo-Sheng
中科院分区：
文献类型：
--
作者：
Wu, Meng-Yu;Lin, Pyng-Jing;Liu, Kuo-Sheng
体外循环生命支持（ECLS）是心切开术后心源性休克（PCS）的一种临时支持。心切开术后ECLS的死亡率通常是由于无法识别合适的患者并在并发症发生前将其过渡到下一次治疗。提出了二次桥转换的双门策略。从2003年1月至2008年1月，72例患者（平均60岁）接受了ECLS治疗PCS。从对ECLS的生理反应中确定心脏恢复的指标。以存活者的支持时间作为心肌恢复的最佳ECLS时间。41例患者脱离ECLS，29例存活出院。ECLS的平均持续时间为130小时。29名幸存者中有28名在7天内脱离了ECLS。ECLS >100小时和持续性低血压（平均动脉压< 70 mm Hg）的难治性现象以及在足够的ECLS（flow > 50 ml.kg（-1）.min（-1），SvO（2）> 80%）>24小时下的高肾上腺素能需求（正性肌力当量评分> 35）是ECLS未脱机的独立危险因素。成人心切开术后ECLS的益处在7天支持后存在争议。对于ECLS >7天或在足够的ECLS >24小时下显示不稳定的合适患者，应考虑桥接。持续的ECLS造成更高的死亡风险。ASAIO Journal 2009; 55：608-613.
Extracorporeal life support (ECLS) is a temporary support of postcardiotomy cardiogenic shock (PCS). Mortality of postcardiotomy ECLS often results from inability to recognize appropriate patients and bridge them to the next therapy before complications. A two-gated strategy for the second bridge transferring was suggested. From January 2003 to January 2008, 72 patients (mean 60 years) received ECLS for PCS. Indicators of cardiac recovery were identified from the physiological responses to ECLS. The optimal ECLS duration for myocardial recovery was defined as the supporting time of survivors. Forty-one patients weaned off ECLS and 29 survived to discharge. The mean duration of ECLS was 130 hours. Twenty-eight of the 29 survivors weaned off ECLS within 7 days. ECLS >100 hours and a refractory phenomenon of persistent hypotension (mean arterial pressure < 70 mm Hg) with a high adrenergic demand (inotropic equivalent score > 35) under a sufficient ECLS (flow > 50 ml.kg(-1).min(-1), SvO(2) > 80%) >24 hours were independent risk factors of ECLS nonweaning. The benefits of adult postcardiotomy ECLS are controversial after a 7-day support. Bridging should be considered in suitable patients having ECLS >7 days or showing instabilities under an adequate ECLS >24 hours. Continuing ECLS poses a higher risk of mortality. ASAIO Journal 2009; 55:608-613.