李景文
中国医学科学院阜外医院 体外循环中心
Refinements in extracorporeal membrane oxygenation (ECMO) equipment, including heparin-coated surfaces, centrifugal pump, membrane oxygenator, and more biocompatible pump-oxygenator circuits, have reduced procedure-related complications and have made ECMO a safe and effective therapy for critical patients. The aim of this study was to evaluate the performance of two different ECMO circuit systems in a clinical setting and compare their outcomes. From December 2004 to December 2009, 121 patients required ECMO for primary or postcardiotomy cardiogenic shock at our heart center. We used the Medtronic circuit system in our earlier series (Group M, n = 64), and from July 2007, ECMO was carried out mainly with the Quadrox D PLS circuit system (Group Q, n = 56). We retrospectively summarized and analyzed the data of these patients. The evaluation was based on the comparison between properties of the membrane oxygenators and pumps, anticoagulation therapy, circuit-related complications, and clinical outcomes. Support pump flow rates, platelet counts, and trans-membrane pressure drops (TMPDs) of preoxygenator and postoxygenator pressures were compared between two groups at the time of support established (T1) and support established for 24 h (T2). There were no significant differences between the two groups with regard to patient characteristics and pre-ECMO data. The support pump flow rates and platelet counts at different times were comparable in the two groups. The cannulation technique, ECMO duration, and mean heparin dosage were similar in both groups. There were also no significant differences between the groups in mortality or complications related to bleeding and organ dysfunction. Compared with the M group, the Q group experienced less mechanical failure of the ECMO circuit. The Quadrox PLS circuit system showed less circuit thrombus formation (P < 0.045), less plasma leakage (P < 0.001), and less need for replacement of oxygenators (P < 0.001). Furthermore, frequency of hemolysis during ECMO was significantly lower (P < 0.045). In addition, at T1 and T2, TMPDs were significantly lower in the Q group. Our results suggest that both ECMO circuit systems provide similar effects for safe clinical application, but the Quadrox PLS ECMO circuit system demonstrated partially improved biocompatibility in terms of improved cell preservation, lower TMPDs, less plasma leakage, and thrombus formation.
Artificial organs 2011
Perioperative hyperglycemia frequently develops in critically ill patients and has been associated with adverse outcome. In this study, we tried to identify whether hyperglycemia was associated with adverse outcome in adult patients receiving extracorporeal membrane oxygenation. From 2004 through 2008, 44 adult patients received extracorporeal membrane oxygenation. Clinical records of these 44 consecutive patients were retrospectively analyzed. Glucose levels were monitored and recorded every 3 hours during the support period. The mean glucose level was computed for all patients for whom data were available within the first 48 hours after extracorporeal membrane oxygenation setup. More than 15% of blood glucose levels above 180 mg/dL were defined as hyperglycemia. Clinical outcomes were compared between patients with and without hyperglycemia. The primary outcome was death from any cause in hospital. A p value < .05 was accepted as significant. The overall survival was 68%. Twenty-eight patients were allocated to group 1 with a mean glucose of 179 +/- 40 mg per deciliter. The other 16 patients allocated to group 2 with a mean glucose of 140 +/- 16 mg per deciliter. There is no significant difference in the mortality of the two groups. Perioperative complications were also similar between the two groups. Glucose levels were not associated with mortality and complications in adult patients receiving extracorporeal membrane oxygenation.
The journal of extra-corporeal technology 2010
The purpose of this study was to retrospectively summarize and analyze the data of 99 cases with the application of consecutive extracorporeal membrane oxygenation (ECMO) from December 2004 to August 2008 in Fuwai Hospital. The intersurface of the ECMO equipment system was completely heparin coated. All patients received venoarterial ECMO, and the activated clotting time was maintained between 120 and 180 seconds. The heparin dose was 5-20 U * kg(-1) * h(-1). Mean blood flow was 40-220 ml * kg(-1) * min(-1) during ECMO assisted period. The shortest ECMO time was 12 hours, and the longest was 504 hours (mean time, 119.45 +/- 80.20 hours). Sixty patients (60.6%) weaned from ECMO successfully; 54 of them (84%) were discharged, and six died of postoperative complications. Thirty-nine patients could not wean from ECMO. Total discharge rate was 54.5%. ECMO is an effective mechanical assistant therapy for cardiac and pulmonary failure after cardiac surgery. Earlier use of ECMO for heart lung failure patients and avoidance of irreversible damage to the main organs are still the key points in the success of ECMO.
ASAIO journal (American Society for Artificial Internal Organs : 1992) 2009
OBJECTIVE:To describe the experience with extracorporeal membrane oxygenation (ECMO) for cardiorespiratory support of 100 patients.METHODS:Retrospective analysis of the medical files of 100 patients submitted to the implant of extracorporeal membrane oxygenation system for cardiorespiratory assistance of acute and refractory cardiogenic shock from December 2004 to September 2008. There were 67 males and 33 females, age ranged from 5 d to 76 years with a mean of (28+/-26) years, body mass ranged from 3.8 to 100.0 kg with a mean of (42+/-30) kg. The inter-surface of the ECMO equipment system was completely coated by heparin-coating technique. All patients were applied veno-artery ECMO and activated clotting time was maintained between 120 and 180 s and heparin usage dose was 5 to 20 Uxkg(-1)xh(-1). Mean blood flow was 40 to 220 mlxkg(-1)min(-1) during ECMO assistant period.RESULTS:The shortest ECMO time was 12 to 504 h with a mean of (119+/-80) h. Sixty-one patients (61.0%) weaned off successfully from ECMO, 55 of them (90.2%) were discharged and 6 died of post-operative complications. Thirty-nine patients could not weaned off from ECMO. Total survival discharge rate was 55.0%. Mean aortic pressure before ECMO in survived patients was significantly higher than that of dead patients (P=0.038). Lactic acid concentration of artery blood before ECMO in survived patients was significantly lower than that of dead patients (P=0.005).CONCLUSIONS:ECMO is an effective mechanical assistant therapy method for cardiac and pulmonary failure after cardiac surgery. Earlier usage of ECMO for heart lung failure patient and avoiding the main organs from un-recovery trauma are key success.
Zhonghua wai ke za zhi [Chinese journal of surgery] 2009
BACKGROUND:Extracorporeal membrane oxygenation is a cardiopulmonary supportive therapy. In this study, we reviewed our experience with extracorporeal membrane oxygenation support and tried to identify measurable values which might predict in-hospital mortality.METHODS:From January 2004 through December 2008, 50 of 21,298 adult patients received venoarterial extracorporeal membrane oxygenation. We retrospectively analyzed clinical records of these 50 consecutive patients. Details of demographics, preoperative measurements, clinical characteristics at the time of extracorporeal membrane oxygenation implantation, extracorporeal membrane oxygenation-related complications and in-hospital mortality were collected. Logistic regression analyses were performed to investigate predictors of mortality. A p-value < or = 0.05 was accepted as significant.RESULTS:Thirty-eight patients were weaned from extracorporeal membrane oxygenation and 33 patients survived to discharge. The overall survival rate was 66%. In a multiple logistic regression analysis, blood lactate level before initiation of extracorporeal membrane oxygenation was a risk factor associated with in-hospital mortality (OR 1.27 95% CI 1.042-1.542). To evaluate the utility of the lactate in predicting mortality, a conventional receiver operating characteristic curve was produced. Sensitivity and specificity were optimal at a cut-off point of 12.6 mmol/L, with an area under the curve of 0.752. The positive and negative predictive values were 73.3% and 83.9%, respectively.CONCLUSIONS:Extracorporeal membrane oxygenation is a justifiable alternative treatment for postoperative refractory cardiac and pulmonary dysfunction which could rescue more than sixty percent of otherwise fatal patients. Patients with pre-extracorporeal membrane oxygenation lactate levels above 12.6 mmol/L are at higher risks for in-hospital death. Evidence-based therapy for this group of high risk patients is needed.
Perfusion 2009
This study examined the effects of different dosages of albumin priming for extracorporeal circuit (ECC) on perioperative fluid status and fluid management in young children. A total of 151 consecutive pediatric patients (2-36 months old) scheduled for open heart surgery, were divided into two groups randomly, to receive either a 3% albumin solution (L group, n = 68) or a 5% albumin (H group, n = 83). Perioperative fluid intake, urine output, blood loss, diuretic dosage, the use of allogeneic blood products, ultrafiltration, and daily balance were recorded for 24 hrs in intensive care unit (ICU). Serial hematocrits, colloid osmotic pressure (COP) were measured. Outcomes and complications were documented. There were no significant differences in demographics, types of surgical procedures, baseline data such as hemoglobin, COP, and serum albumin. Patients in H group had significantly higher COPs, less urine output and more diuretic usage during operation and postoperatively (p < 0.05); at 6 hrs postoperatively, there were no differences between two groups. No statistically significant differences were found between the two groups in blood loss and the amount of allogenic blood products infused, length of mechanical ventilation, ICU or hospital stay, complications, or mortality. Higher concentration of albumin prime in ECC showed decreased positive fluid balances, but produced less urine output and required more diuretic usage postoperatively. Thus, no significant clinical benefit resulted from the increased dosage.
ASAIO journal (American Society for Artificial Internal Organs : 1992) 2008
