Clinical application of extracorporeal membrane oxygenation for treatment of adult refractory cardiogenic shock
10.3760/cma.j.issn.0253-3758.2013.07.016
- VernacularTitle:体外膜肺氧合在成人心原性休克救治中的临床应用
- Keywords:
Shock,cardiogenic;
Risk factors;
Extracorporeal membrane oxygenation
- From:
Chinese Journal of Cardiology
2013;41(7):590-593
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) treatment for adult refractory cardiogenic shock.Methods From January 2003 to January 2011,patients with refractory cardiogenic shock required veno-arterial ECMO by failure of conventional therapy and intra-aortic balloon pump counterpulsation therapy were retrospectively studied.Patients with severe traumatic brain injury,advanced malignancies and multiple organ failure were excluded.Patients were divided into weaned group(n =31) and not weaned group(n =23) according to the ECMO weaning.Results The duration of ECMO was 24.16(14.12,56.75) hours.Twenty-two out of 31 patients in the weaned group survived and were discharged,9 patients died after successfully weaned from ECMO (5 due to multisystem organ failure,2 due to reoccurred cardiogenic shock,1 due to infectious shock and 1 due to disseminated or diffuse intravascular coagulation).Pre-ECMO mean arterial pressure,ejection fraction,the duration of ECMO were significantly higher while pre-ECMO blood lactate [(8.64 ± 3.17) vs.(14.44 ± 2.52),P ＜0.01],the duration of ROSC [(16.70 ± 5.29) vs.(35.64 ± 5.89),P ＜0.01] and multisystem organ failure [0 vs.17.4％ (4/23),P ＜0.05] were lower in weaned group than in not wean group.Conclusions ECMO is an effective mechanical assistant therapy strategy for adult refractory cardiogenic shock patients.Timely applying this strategy on suitable patients is crucial for the success of ECMO.Cardiac function and reversibility of heart failure are key factors determine the fate of weaned or not weaned ECMO in adult refractory cardiogenic shock patients.
