静脉动脉外体膜氧化用于心脏性休克
Aravdeep Jhand1, Muhammad Asim Shabbir2, John Um3
1Cardiovascular Medicine, Mayo Clinic; jhand.aravdeep@gmail.com.
Journal of visualized experiments : JoVE
|September 7, 2023
概括
静脉动脉 (VA) 外体膜氧化 (ECMO) 在急性心肌梗塞 (AMI) 后为心脏性休克 (CS) 提供短期的循环支持. 存活率各不相同,目前正在进行的研究旨在确认其对患者存活率的影响.
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:
- 心脏性休克 (CS) 是由于心脏输出量低而导致组织 perfusion 不足的关键状态,通常是急性心肌梗塞 (AMI) 之后.
- 暂时的机械循环支持装置对于CS的血液动力稳定至关重要.
- 静脉动脉外体膜氧化 (VA-ECMO) 已成为耐火性CS.的重要干预措施.
研究的目的:
- 审查VA-ECMO在心脏性休克管理中的当前理解和应用.
- 突出VA-ECMO治疗的技术方面,管理方面的考虑和禁忌.
- 讨论VA-ECMO在正在进行的临床研究的背景下不断变化的作用.
主要方法:
- 对CS的VA-ECMO临床经验,注册表数据和观察性研究的审查.
- 描述VA-ECMO电路组件和管技术 (通过皮肤或手术).
- 讨论包括抗凝血,左心室卸载和并发症预防在内的基本管理策略.
主要成果:
- 在VA-ECMO支持下,存活到出院的概率在28%至67%之间.
- 关键的管理方面包括抗凝血,左心室卸载,并预防肢体缺血和其他并发症.
- 禁忌包括不受控制的出血,未经修复的大动脉剖析,严重的大动脉缺陷和徒劳性.
结论:
- VA-ECMO是一种强大的工具,用于在耐火性心脏性休克中提供短期的循环支持.
- 建议采用多学科冲击团队的方法来选择患者.
- 需要进行进一步的随机试验,以确定常规VA-ECMO在CS的AMI患者的最终生存益处.
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