Long-Term Survival After Extracorporeal Membrane Oxygenation Therapy: The Attention It Deserves!
Long-Term Survival After Extracorporeal Membrane Oxygenation Therapy: The Attention It Deserves!
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体外膜氧合治疗后的长期生存：值得关注！
DOI：
10.1097/ccm.0000000000002114
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发表时间：
2017
影响因子：
8.8
通讯作者：
Weber-Carstens S
中科院分区：
文献类型：
--
作者：
Pickerodt PA;Francis RC;Weber-Carstens S
不幸的是，von Bahr等人（7）没有报道上述通气或连续治疗束。需要解决的另一个方面是：鉴于其工作的回顾性性质，作者无法报告除生存率外的以患者为中心的结局指标。ECMO治疗呼吸衰竭患者的健康相关生活质量持续下降，认知障碍，焦虑，抑郁和创伤后应激障碍的发生率高;因此，孤立地报告生存率已不再足够（13）。令人震惊的是，本研究中的17例晚期死亡中有3例是由中毒引起的，包括一例一氧化碳中毒。由于严重ARDS的死亡率仍高达46%（14），如果在瑞典卡罗林斯卡医学院等卓越中心应用ECMO，显然可以挽救生命。我们现在需要严格的前瞻性测试的生理合理的治疗原则，以进一步降低死亡率和改善生活质量和独立功能后，ECMO严重ARDS。随着越来越多的医院采用ECMO，我们必须确保技术进步和扭曲的财政激励措施不会在不了解我们的干预措施对有意义的生存的影响的情况下将我们推到驾驶座上。换句话说（错误地归因于著名的物理学家阿尔伯特爱因斯坦）：“任何一个在亲吻一个漂亮女孩时能安全驾驶的男人，只是没有给予这个吻应有的关注”！
Unfortunately, none of the above described ventilatory-or adjunctive-treatment bundles are reported by von Bahr et al (7). One further aspect needs to be addressed: given the retrospective nature of their work, the authors are not able to report on patient-centered outcome measures apart from survival. Patients surviving ECMO for respiratory failure suffer from persistent reduction of health-related quality of life, cognitive impairment, and high frequency of anxiety, depression, and posttraumatic stress disorder; thus, it is no longer adequate to report survival in isolation (13). Alarmingly, three of 17 late deaths in the present study were caused by intoxication, including a case of carbon monoxide poisoning. With the mortality of severe ARDS remaining at a disappointingly high of 46%(14), it is becoming evident that ECMO may save lives if applied in centers of excellence such as the Karolinska Institute in Sweden. We now need stringent prospective testing of physiologically sound treatment principles to further reduce mortality and improve quality of life and independent functioning after ECMO for severe ARDS. With greater uptake of ECMO by more hospitals, we must ensure that technologic advances and distorting financial incentives do not thrust us into the driver’s seat without understanding the impact of our interventions on meaningful survival. In other words (wrongfully attributed to famous physicist Albert Einstein):“Any man who can drive safely while kissing a pretty girl is simply not giving the kiss the attention it deserves”!
影响因子：
38.9
作者：
Lewandowski, K;Rossaint, R;Falke, KJ
通讯作者：
Falke, KJ
重点关注成人严重 ARDS 的静脉-静脉 ECMO
影响因子：
38.9
作者：
L. Papazian;M. Herridge;A. Combes
通讯作者：
A. Combes
影响因子：
158.5
作者：
Amato, Marcelo B. P.;Meade, Maureen O.;Brower, Roy G.
通讯作者：
Brower, Roy G.