严重创伤的成年患者的ECMO:系统审查和元分析
Yangchun Zhang1, Li Zhang1, Xihua Huang1
1Emergency Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
European journal of medical research
|October 9, 2023
概括
身体外膜氧化 (ECMO) 显示,严重创伤患者的生存率为65.9%. 静脉-动脉ECMO的存活率低于静脉ECMO,这表明其在重症监护中的潜在益处.
科学领域:
- 关键护理医学 关键护理医学
- 创伤外科 手术 创伤外科
- 心肺支 提供心肺支
背景情况:
- 严重的创伤可能导致心肺衰竭,对传统治疗没有反应.
- 身体外膜氧化 (ECMO) 是一种辅助疗法,但其在创伤中的指示和结果尚未明确.
- 这项研究旨在澄清ECMO在成人创伤患者的预后价值.
研究的目的:
- 描述需要ECMO的成年创伤患者的预后.
- 为ECMO在创伤中的使用提供临床决策的信息.
- 以指导未来关于ECMO在创伤护理中的研究.
主要方法:
- 在主要数据库 (PubMed,Embase,Cochrane,Scopus) 进行了系统的文献搜索,直到2023年3月.
- 对36项观察性研究 (1822名患者) 进行了元分析,以评估生存率和其他结果.
- 研究质量和证据确定性使用乔安娜·布里格斯研究所的检查清单和GRADE方法进行评估.
主要成果:
- 在ECMO治疗中,创伤患者的综合存活率为65.9%.
- 创伤性脑损伤 (TBI) 和非TBI创伤的生存率相似 (分别为66.1%和68.1%).
- 与静脉动脉ECMO (VA ECMO) (39.0%) 相比,静脉动脉ECMO (VV ECMO) 的生存率显著更高 (72.3%).
结论:
- 对于严重创伤的患者来说,ECMO是有益的,改善了结果.
- 它是管理创伤相关心肺衰竭,休克和停止的宝贵工具.
- 聚合生存的证据确定性很高,支持ECMO在重症创伤护理中的作用.
相关概念视频
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
10
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
10
01:26Flail Chest-II
184
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
Assessment:
1. Clinical Evaluation:
History:
184
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
12
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
12
01:21Cardiopulmonary Resuscitation I: Adult
18
Cardiopulmonary resuscitation, or CPR, is a life-saving emergency procedure performed when a person's heart has stopped beating or they are no longer breathing. The foundation of CPR is Basic Life Support (BLS), which focuses on the early recognition of cardiac arrest, the immediate start of high-quality chest compressions, and the timely use of an automated external defibrillator (AED).Assessing Responsiveness and Checking the Carotid PulseWhen approaching an unresponsive person, first ensure...
18