Clinical analysis of extracorporeal membrane oxygenation for 26 adult patients after cardiac surgical procedures
10.7507/1007-4848.201809039
- VernacularTitle:体外膜肺氧合用于成人心脏外科术后 26 例临床分析
- Author:
AMUTI Mulatijiang
1
;
ZHU Kai
1
;
ZHANG Hongqiang
1
;
LI Xin
1
;
LUO Zhe
2
;
YANG Shouguo
1
;
SUN Xiaoning
1
;
WANG Chunsheng
1
Author Information
1. Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P.R.China
2. Department of Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai, 200032, P.R.China
- Publication Type:Journal Article
- Keywords:
Extracorporeal membrane oxygenation;
cardiac surgical procedures;
complications;
low cardiac output syndrome;
prognosis
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2019;26(7):674-680
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) in adult patients with cardiac surgery, analyze the risk factors associated with the mortality and other severe complications and to discuss prevention methods of complications during ECMO treatment. Methods The clinical data of 26 patients with cardiac surgery, who underwent ECMO because of cardiopulmonary insufficiency ect in Zhongshan Hospital, Fudan University from January 2012 to September 2017, were retrospectively analyzed. There were 19 males and 7 females aged 24–80 (58.0±13.9) years. Results Twelve (42.3%) patients successfully weaned from ECMO and six (23.1%) were discharged from hospital. Among 26 patients, 24 received VA ECMO (veno-arterial ECMO), including 5 after heart transplantation, 9 after heart valve surgery, and 3 were successfully weaned from ECMO. Seven patients with valvular surgery underwent ECMO within 48 hours due to refractory low cardiac output syndrome (LCOS). Eight patients underwent major angioplasty, 3 of whom were successfully weaned from ECMO. Four patients underwent coronary artery bypass grafting and other cardiac surgeries. Patients with VA ECMO were treated with femoral vein-femoral artery cannulation except for 2 patients undergoing femoral vein-radial artery cannulation after major angioplasty. Patients with VV ECMO (veno-venous ECMO) underwent femoral vein-jugular vein cannulation. After ECMO support, 10 patients with bleeding occurred, and 5 patients were successfully weaned from ECMO. All patients had transfusion therapy during the assist period, 7 patients had infection after ECMO support, 4 patients suffered severe distal limb ischemia. There was no significant difference in the lactic acid between the survival and the dead patients before and after ECMO support. However, the decline of serum lactic acid in the survivors was faster than that of the dead patients. The trend was the most significant within 6 h after the operation. Conclusion ECMO is one of the significant treatments for LCOS and refractory hypoxemia after cardiac surgery. The type of cardiac surgery and the timing of catheter placement are key factors for the success of ECMO. The different ways of ECMO intubation, prevention and control of bleeding during ECMO, monitoring and management of internal environment and the strategies of anti-infection are all important for success of ECMO.
