Clinical observation of venous-arterial extracorporeal membrane oxygenation in the treatment of refractory septic shock in children
10.3760/cma.j.issn.1671-0282.2019.06.008
- VernacularTitle:静脉-动脉型体外膜肺氧合治疗儿童难治脓毒性休克的临床疗效观察
- Author:
Yun CUI
1
;
Fei WANG
;
Yuqian REN
;
Yiping ZHOU
;
Jingyi SHI
;
Tingting XU
;
Jiangbin LIU
;
Yucai ZHANG
Author Information
1. 上海交通大学附属儿童医院重症医学科 200062
- Keywords:
Venoarterial extracorporeal membrane oxygenation (VA-ECMO);
Continuous renal replacement therapy (CRRT);
Sepsis;
Refractory septic shock;
Mortality;
Child
- From:
Chinese Journal of Emergency Medicine
2019;28(6):697-701
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the efficacy of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in the treatment of refractory septic shock in children.Methods From January 2016 to December 2018,the clinical data of children with refractory septic shock (RSS) treated by VA-ECMO in Department of Critical Medicine Affiliated Children's Hospital of Shanghai Jiao Tong University were retrospectively analyzed.The patients with refractory septic shock (RSS) treated by VA-ECMO were compared with those with non-refractory septic shock (NRSS).Results There were 8 cases in the RSS-ECMO group and 6 cases in the NRSS-ECMO group.The sex,age,PRISM score,complication showed no significant difference in the two groups.The median time of ECMO in the RSS-ECMO group was 182 (141,216) h,and 5 patients were survived and were discharged from the hospital.The blood lactic acid and vasoactive drug index in the RSS-ECMO group was significantly higher than that in the NRSS-ECMO group (P＜0.05 or P＜0.01).The time of vasoactive drugs use and the ratio of combined continuous renal replacement therapy (CRRT) in the RSS-ECMO group were higher than those in the NRSS-ECMO group,but there was no significant difference (P ＞ 0.05).Atter ECMO establishment,the mean invasive arterial pressure increased significantly at 6 h,and lactic acid decreased significantly at 12 h after ECMO support.SCVO2 returned to normal at 24-h ECMO therapy.Conclusions The success rate of VA-ECMO treatment in children with refractory septic shock complicated with MODS is similar to that of children with non-refractory septic shock.The relationship between ECMO and hemodynamic indexes in sepsis should be further explored.
