对于成人和儿童的败血性休克而言,体外膜氧化:叙述性综述
Lars Mikael Broman1,2, Olga Dubrovskaja3, Martin Balik4
1ECMO Centre Karolinska, Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176 Stockholm, Sweden.
Journal of clinical medicine
|October 28, 2023
概括
静脉动脉外体膜氧化 (VA ECMO) 可以支持耐火性败血性休克患者的心脏指数低. 不推用于高动力性败血性休克或晚期复苏.
科学领域:
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
- 身体外生命支持器
背景情况:
- 耐火性败血性休克带有高死亡风险.
- 静脉动脉外体膜氧化 (VA ECMO) 是为儿科血动力学支持而建立的.
- 对于低动力性败血症休克,VA ECMO的成年生存率在70-90%之间.
研究的目的:
- 确定VA ECMO在耐火性败血栓冲击中的适用情况.
- 为了澄清VA ECMO在不同败血症休克表型中的作用.
- 建立基于血液动力学参数的VA ECMO启动标准.
主要方法:
- 审查现有的文献和关于VA ECMO在败血症休克中使用的观察数据.
- 血液动力学参数的分析,包括心脏指数 (CI) 和全身血管阻力.
- 根据VA ECMO启动的冲击类型和时间对结果的评估.
主要成果:
- 对于高动力性败血性休克或晚期心肺复苏,不建议使用VA ECMO.
- 考虑VA ECMO当心脏指数 (CI) 下降到2.5L/分钟m-2以下,系统血管阻力较低时.
- 在特定人群中,VA ECMO的指示包括心脏性休克 (CI <1.8 L/min m-2) 或耐火性血管解与保存CI.
结论:
- 对于精选的耐火性败血性休克患者来说,VA ECMO是一种可行的恢复桥梁.
- 血液动力学标准,特别是低心脏指数,对于VA ECMO考虑至关重要.
- 感染性休克的体外支持应集中在大量的ECMO中心.
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