左心室辅助装置和电风暴患者的动态体外生命支持:一个案例报告
Joseph Michael Brewer1,2, Obaid Ashraf1, Jordan Phillips1
1From the INTEGRIS Health Baptist Medical Center, Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, Oklahoma City, Oklahoma.
ASAIO journal (American Society for Artificial Internal Organs : 1992)
|October 27, 2025
概括
在左心室辅助器械 (LVAD) 患者中,管理电风暴和心脏骤停是复杂的. 本案例报告详细介绍了分阶段的体外膜氧化 (ECMO) 支持,从VA ECMO过渡到混合VAP和VP ECMO以获得血液动力稳定性.
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:
- 电风暴 (ES) 和心脏骤停在左心室辅助器件 (LVAD) 患者中构成重大挑战.
- 在LVAD患者中,静脉外体膜氧化 (VA ECMO) 用于体外心肺复苏 (ECPR) 呈现出血动力学复杂性.
- 其他ECMO配置可以提供量身定制的支持.
研究的目的:
- 描述了一个新植入LVAD的患者的管理,该患者经历了电风暴,心脏骤停和耐火右心室衰竭.
- 为了说明在这个复杂的临床场景中使用分阶段ECMO支持,包括VA,混合VAP和VPECMO.
主要方法:
- 病例报告详细介绍了一名患有新LVAD的患者,该患者患有ES和心脏骤停.
- 最初的支持涉及VA ECMO的ECPR.
- 随后的支持转向混合静脉脉肺 (VAP) ECMO,然后根据不断变化的血液动力学要求转向静脉肺 (VP) ECMO.
主要成果:
- 患者需要复杂的,多阶段的ECMO支持.
- 在不同ECMO模式 (VA到VAP到VP) 之间成功过渡.
- 这种分阶段的方法解决了患者的动态血液动力学需求.
结论:
- 阶段性ECMO支持,适应VA,VAP和VP配置,对于经历电风暴和心脏骤停的LVAD患者来说,这可能是一个可行的策略.
- 根据特定的血液动力学挑战调整ECMO模式对于管理这些重症患者至关重要.
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