[静脉外体膜氧化:从证据到临床实践]
Luigi Oltrona Visconti1, Rita Camporotondo1, Marco Ferlini1
1Divisione di Cardiologia, IRCCS Policlinico San Matteo, Pavia.
概括
静脉外体膜氧化 (VA-ECMO) 提供完整的循环和呼吸支持,但在心脏病相关的休克中未经选择的早期使用不会改善生存率. 精心选择患者对于有效的VA-ECMO治疗至关重要.
科学领域:
- 心脏病学 心脏病学
- 临界护理医学 临界护理医学
- 机械循环支持 机械循环支持
背景情况:
- 尽管药物治疗,心脏病性休克仍然存在高死亡率.
- 机械循环支持,包括静脉脉外体膜氧化 (VA-ECMO),越来越多地使用.
- VA-ECMO提供全面的循环和呼吸支持.
研究的目的:
- 评估早期,未经选择的VA-ECMO在心脏病发作相关心脏病性休克中使用的疗效和安全性.
- 确定VA-ECMO在严重心脏病中目前的指示.
- 强调VA-ECMO实施专业中心的重要性.
主要方法:
- 关于VA-ECMO的最新数据和临床实践指南的审查.
- 分析与未选择的早期VA-ECMO在心脏病相关休克中相关的结果.
- 确定可能从VA-ECMO中受益的患者子组.
主要成果:
- 无选择的早期VA-ECMO在心脏病发作相关的休克并没有改善生存率.
- 相关并发症包括严重出血和外周缺血症.
- 目前的适应症侧重于心脏骤停,耐心心力衰竭,心肌炎或等待移植/辅助器件的选定患者.
结论:
- VA-ECMO是一个有价值的工具,但需要仔细选择患者,特别是在心脏病相关的休克中.
- 最佳利用涉及专业化,高容量中心在一个枢纽和支柱模型.
- 需要进一步的随机对照试验来完善VA-ECMO协议.
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