早期的左心室通风与在静脉外体膜氧化支持期间的左心室减压的常规治疗:EVOLVE-ECMO随机临床试验
Hanbit Park1,2, Jeong Hoon Yang3, Jung-Min Ahn1
1Division of Cardiology, Department of Internal Medicine, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea.
European journal of heart failure
|August 29, 2023
概括
在静脉外体膜氧化 (VA-ECMO) 过程中早期的左心室卸载并没有改善断奶率. 虽然它改善了肺堵塞,但这种策略在VA-ECMO插入后没有得到支持.
科学领域:
- 心脏病学 心脏病学
- 心血管外科心血管外科
- 关键护理医学 关键护理医学
背景情况:
- 在静脉脉外体膜氧化 (VA-ECMO) 期间,心脏骤停或休克时,左心室 (LV) 卸载的最佳时间仍未得到充分研究.
- 关于早期与传统LV卸载策略的好处的数据有限.
研究的目的:
- 与VA-ECMO患者的传统方法相比,评估早期LV卸载策略的可行性和影响.
- 评估早期 LV 卸载对 VA-ECMO 断奶率和肺堵塞的影响.
主要方法:
- 一个随机对照试验,涉及60名患者,比较早期 (在VA-ECMO插入时) 与传统的LV卸载.
- LV卸载使用皮肤穿越的左侧心房管.
- 主要终点是VA-ECMO断奶率;次要终点包括生存率和肺堵塞得分.
主要成果:
- 早期卸载组与传统卸载组之间在VA-ECMO断奶率 (70.0%与76.7%) 或存活到卸载时的存活率 (53.3%与50.0%) 上没有显著差异.
- 早期LV卸载组在卸载后48小时显示肺堵塞得分指数显著改善 (p=0.008).
结论:
- 与传统策略相比,在VA-ECMO期间早期卸载LV并没有改善VA-ECMO的断奶率.
- 尽管肺堵塞迅速改善,但该研究不支持在VA-ECMO插入后常规应用这种早期LV卸载策略.
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