Despite significant advances in the field of critical care medicine over the past three decades, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) remains the primary temporary mechanical circulatory support modality for patients with acute severe circulatory failure. With the accumulation of clinical experience and the increasing maturity of operational techniques in V-A ECMO, its technical management—particularly hemodynamic management—has become a key factor influencing patient outcomes. To further improve patient survival, the Chinese Critical Care Ultrasound Study Group, in collaboration with the Hemodynamic Therapy of Critical Care Collaborative Group and the Critical Care Medicine Branch of the China International Exchange and Promotive Association for Medical and Health Care, organized experts in critical care medicine to develop the Consensus on Hemodynamic Management in Adult Veno-Arterial Extracorporeal Membrane Oxygenation (2026 Edition). Based on years of clinical experience and the latest evidence-based medical evidence, this consensus formulates 15 systematic recommendations covering the entire process of V-A ECMO, including initiation, management during support, and weaning, aiming to promote standardized application of hemodynamic management in V-A ECMO.

With the widespread application of extracorporeal membrane oxygenation (ECMO) technology, ECMO centers have been established in most regions of China, and the demand for ECMO transport is also increasing. Critically ill patients with ECMO carry many catheters. ECMO devices and accessories are cumbersome and numerous, requiring a large amount of manpower to assist in the transfer. At present, most of ECMO transport equipment are vertical carts provided by equipment suppliers, which cannot accommodate all ancillary equipment and are difficult to be loaded into ambulances for transportation. Therefore, critically ill patients face many risks if they need to be transported inter-hospital. A specific vehicle for ECMO patients was designed by the medical staff of the department of critical care medicine of Zhujiang Hospital of Southern Medical University, which integrates the ECMO host, oxygenator, centrifugal pump, portable ventilator, coagulation instrument, injection pump, monitor, oxygen cylinder, and etc., to greatly facilitate the transportionation. This invention obtained the National Utility Model Patent of China (ZL 2019 2 1201261.4). The new ECMO transport vehicle can facilitate the interhospital transport of critically ill patients, reduce the occurrence of accidents, shorten the transport time and reduce the number of transport personnel, and has a good clinical application value.

OBJECTIVETo explore the role of central venous pressure (CVP), global end diastolic volume index (GEDI) and extravascular lung water index (ELWI) monitoring in patients with septic shock during fluid resuscitation by pulse induced continuous cardiac output (PiCCO) test.

METHODSForty-six patients with severe sepsis and septic shock were enrolled in this study. Hemodynamic monitoring was performed during fluid resuscitation and the data including CVP, GEDI and ELWI were collected to analyze their relationship and the clinical values.

RESULTSIn patients with septic shock, CVP showed a weak linear correlation with GEDI during fluid resuscitation (r=0.137, P=0.009). In the subgroups stratified with CVP cut-off values of 8 mmHg and 12 mmHg, the correlation coefficient between CVP and GEDI was 0.149 (P=0.029) in CVP<8 mmHg group, 0.075 (P=0.462) in 8 mmHg ≤ CVP ≤ 12 mmHg group, and 0.049 (P=0.726) in CVP>12 mmHg group. In the total of 367 data groups obtained, CVP showed no linear correlation with ELWI (r=0.040, P=0.445). In the CVP subgroups, CVP and ELWI were weakly correlated in CVP<8 mmHg group (r=0.221, P=0.001), but they showed no correlations in 8 mmH g≤ CVP ≤ 12 mmHg and CVP>12 mmHg groups (r=-0.047, P=0.646; r=0.042, P=0.765).

CONCLUSIONThere is no significant linear correlation between CVP and GEDI or between CVP and ELWI in patients with septic shock. CVP can not reflect the circulatory blood volume or the degree of pulmonary edema.

Blood Volume ; Cardiac Output ; Central Venous Pressure ; Extravascular Lung Water ; Fluid Therapy ; Humans ; Pulmonary Edema ; Resuscitation ; Shock, Septic ; therapy

Objective To compare the rates of clearance of different solutes during continuous veno-venous haemodiafiltration (CVVHDF) between pre-dilution and post-dilution.Methods A study in vitro was carried out using model CRRT system with AN69 filter used,which was applied to perform CVVHDF for solutes clearance.The removed amounts of different solutes including potassium ion (K +),creatinine (Cr),vancomycin,insulin,and interleukin-6 (IL-6) were determined in the groups of control (without dilution),pre-dilution and post-dilution during CVVHDF at the same substitution fluid amount.Each group was repeated 4 times (n =4).Results Post-dilution mode increased K +,Cr,vancomycin and insulin clearances significantly.There was no difference in clearance of IL-6 between the pre-and post-dilution groups.In the control group,insulin and IL-6 levels were decreased extremely.Conclusions In general,the rate of clearance using post-dilution of CVVHDF is higher than that using pre-dilution.Among high molecular weight solutes,the difference in clearance is not significant.The control group demonstrates insulin and IL-6 adsorbed by the filter.

A patient with skin rash, skin denudation, anuria, general dropsy and dyspnea for unknown etiology underwent continuous renal replacement therapy (CRRT) for 3 consecutive days. The biochemical indexes were monitored during the therapy and biopsy was performed on the right thigh. Pathological examination of the biopsy sample established the diagnosis of polymyositis(PM) and dermatomyositis(DM). After the start of CRRT, the patient's heart, liver, kidney and lung injuries showed obvious improvement, and the urine volume (UV) increased and serum creatinine (Cr), urea, total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase (CK), creatine kinase isoenzyme (CK-MB) and lactate dehydrogenase (LDH) levels all decreased promptly. The patient showed progressive improvement of the physiological condition even after CRRT, and was discharged 10 days later. This case suggests the efficacy of CRRT in the management of severe PM/DM and its value as a good option for treatment of severe autoimmune disease, especially systemic inflammatory response syndrome.
Adult ; Dermatomyositis ; therapy ; Humans ; Male ; Polymyositis ; therapy ; Renal Replacement Therapy ; Treatment Outcome