Objective To analyze the current situation of civil cardiopulmonary bypass, then to give suggestion and prediction for the future of civil cardiopulmonary bypass (CPB). Methods Civil hospitals carrying out cardiac operations were inquired with questionnaires annually concerning the scope of cardiac operations being carried out, the ratio of onpump operations and offpump operations, the situation of extracorporeal membrane oxygenation(ECMO), the composition of CPB technicians, and oxygenators being utilized, et al. Results 76 319 cases of cardiac operations were performed in 2003, while 136 015 cases of cardiac operations were performed in 2007 (among them 113 465 cases were CPB, account for 83.42% of cardiac operations). 41 hospitals carried out 153 cases of extracorporeal membrane oxygenation(ECMO) in 2007. The rate of membrane oxygenator(import) utilization was 46.16%, and the rate of membrane oxygenator(made in China) utilization was 23.9% in 2007. There were 1 497 persons engaged in of CPB in 2007, and among them 55% were doctors. All the perfusionisters had not been trained normally so far. Conclusion Cardiac surgery and CPB technique make rapid progress in china, so persons engaged in CPB need to be trained normally and systematically. In recent years, more and more membrane oxygenators are utilized, and there is a trend that bubble oxygenators would be abandoned finally.
Although extracorporeal membrane oxygenation (ECMO) has been in existence since the 1970s as a means of supporting respiratory or cardiac function, early application of this technology was plagued by high complication rates. Peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) causes higher left ventricular end-diastolic pressure, pulmonary edema, left ventricular distention, ventricular arrhythmia, low coronary perfusion, myocardial ischemia, substantial thrombus formation within left ventricule cavity and even multiple organ dysfunction. Mechanical left ventricular decompression is required to treat these related complications. In this article, we reviewed the problems associated with left ventricular decompression supported by peripheral V-A ECMO in patients with cardiogenic shock.
Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.
ObjectiveTo evaluate the monitoring value of brain injury biomarkers in the patients during extracorporeal membrane oxygenation (ECMO). MethodsWe searched PubMed, EMbase, the Cochrane Library, CNKI, and CBM from inception of each database to May 2015 to identify randomized controlled trials, or case-control trials, or cohort trials of brain injury biomarkers predict brain injury during ECMO. Data were extracted independently by two reviewers. Meta-analysis was conducted using STATA 12.0 software. ResultsFour retrospective trials were included. The results showed that compared with patients without brain injury, the patients with brain injury had a higher level of S100B protein (P < 0.05). The incidence of major neurological events was higher for high neuron-specific enolase level patients than mild-to-moderate neuron-specific enolase level patients (85% vs. 29%, P=0.01). The incidence of brain injury was higher for normal glial fibrillary acidic protein level than patients with glial fibrillary acidic protein > 0.436 ng/ml (OR=11.5, 95%CI 1.3-98.3). ConclusionsBrain injury biomarkers may be used as an indicator for earlier diagnosis of brain injury in patients during ECMO.
Objective To explore the feasibility and safety of extracorporeal membrane oxygenation (ECMO) to support the airway reconstruction for the patients with airway obstruction or stenosis who cannot be ventilated routinely. Methods There were 3 patients received trachea reconstruction procedures assisted by ECMO. Among the patients, 2 cases with tracheal neoplasms underwent fibrobrochoscopy treatments, another one with endotracheal stenosis and fistula received tracheoplasty and semi-tracheostomy. Results ECMO can provide enough oxygenation for the patients with airway obstruction or stenosis and more time for advanced therapies. All three patients recovered after interventional surgeries, in whom one case died due to multiple organ failure caused by esophageal carcinoma metastasis after 3 months, and the others survived with dyspnea classification of 2-3 grade. Conclusion ECMO can be a safe and effective approch for the patients who cannot be ventilated conventionally in airway reconstruction.
Objective To summarize the clinical manifestations, diagnosis and treatment of severe primary graft dysfunction ( PGD grade 3 ) in early stage after lung transplantation. Methods From September 2002 to December 2010, there were 10 patients with severe PGD ( grade 3) in early stage after lung transplantation ( LTx) in 100 patients with end-stage lung disease underwent LTx in Wuxi People’s Hospital. In which there were 2 cases with chronic obstructive pulmonary disease, 4 with idiopathic pulmonary fibrosis,1 case with lung tuberculosis, 1 case with silicosis, 2 cases with bronchiectasis. There were 7 patients with single LTx [ 3 cases with extracorporeal membrane oxygenation ( ECMO) support] and 3 patients with bilateral LTx ( 1 case with ECMO support) . Results The surgical procedures of these 10 patients were successful, however severe PGD occurred on 1-5 days after operation. 4 cases died of respiratory failure with negative fluid balance and mechanical ventilation support, and 2 cases recovered. 4 cases underwent ECMO support, in which 2 cases successfully weaned from ECMO and discharged from hospital, others died of multiple organ failure.Conclusions Severe PGD is one of the fatal early complication after lung transplantation. Early diagnosis and treatment are very important to improve the perioperative mortality rate.
ObjectiveTo explore the clinical value of fibrinogen-albumin-ratio (FAR) in adult extracorporeal membrane oxygenation (ECMO) hemorrhage. MethodsThe clinical data of adult patients receiving ECMO in the West China Hospital from 2018 to 2020 were analyzed retrospectively. Patients were divided into a bleeding group and a non-bleeding group based on whether they experienced bleeding after ECMO. Logistic regression analysis was used to study the relationship between FAR and bleeding, as well as risk factors for death. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to analyze the predictive ability of FAR. According to the optimal cut-off value of FAR for predicting hemorrhage, patients were divided into a high-risk group and a low-risk group, and the occurrence of bleeding was compared between the two groups. ResultsA total of 125 patients were enrolled in this study, including 85 males and 40 females, aged 46.00 (31.50, 55.50) years. Among them, 58 patients received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and 67 patients received veno-venous extracorporeal membrane oxygenation (VV-ECMO). There were 49 patients having bleeding, and the lactate level was higher (P=0.026), the platelet count before ECMO initiation and 24 h after ECMO initiation was lower (P=0.031, 0.020), the fibrinogen level 24 h after ECMO initiation was lower (P=0.049), and the proportion of myocarditis patients was higher (P=0.017) in the bleeding group than those of the non-bleeding group. In the subgroup analysis of ECMO mode, the higher D-Dimer, lactate level and lower FAR before and 24 h after ECMO initiation were associated with bleeding in the VA-ECMO group (P=0.017, 0.011, 0.033, 0.005). The 24 h FAR was independently correlated with bleeding (P=0.048), and AUC was 0.714. The cut-off value was 55.73. According to this optimal cut-off value, 25 patients were divided into the high-risk group (≤55.73) and 33 into the low-risk group (>55.73). There was a higher incidence of bleeding in the high-risk group compared to the low-risk group (unadjusted P=0.002; P=0.013 for multivariable adjustment). In the VV-ECMO group, the relationship between FAR and bleeding events was not significant (P>0.05). ConclusionLow 24 h FAR is an independent risk factor for bleeding in VA-ECMO patients, and the diagnostic cut-off value is 55.73.
A 69-year-old male was presented with exercise intolerance and progressive exertional dyspnea for 3 months. His main clinical diagnosis were degenerative valvular disease, severe aortic stenosis, severe aortic regurgitation, severe mitral regurgitation, severe tricuspid regurgitation, ventricular electrical storm, chronic heart failure, and New York Heart Association (NYHA) class Ⅳ heart function. He was encountered with sudden ventricular electrical storm in the emergency room. Extracorporeal membrane oxygenation (ECMO) was impanted beside during cardiopulmonary resuscitation. Emergency transcatheter aortic valve replacement (TAVR) was successfully performed under the guidance of transesophageal echocardiography when hemodynamics permitted. ECMO was withdrawn on the 5th day and discharged on the 21st day. TAVR is safe and effective for the treatment of high-risk aortic stenosis, and ECMO support is the key for the success of cardiopulmonary resuscitation.
Abstract： Objective To summarize the clinical experiences of performing extracorporeal membrane oxygenation (ECMO) on patients with heart and respiratory failure, and compare the clinical outcomes of Medtronic system and Quadrox PLS system. Methods We retrospectively analyzed the clinical data of 121 heart and respiratory failure patients who underwent ECMO treatment in Fu Wai Hospital from December 2004 to December 2009. Based on the different systems used, 121 patients were divided into two groups. In group M, there were 65 patients including 41 males and 24 females, with an age of 26.6±25.9 years; and they accepted Medtronic ECMO system treatment. In group Q, there were 56 patients including 39 males and 17 females, with an age of 32.4±23.9 years and they underwent Quadrox PLS ECMO system treatment. The evaluation of the clinical outcomes of these two different systems was based on the comparison of transmembrane pressure drop (TMPD), anticoagulation, hemolysis, plasma leakage, organ function, complication and hospital mortality between the two groups. Results Compared with group M, ECMO with Quadrox PLS system was associated with lower TMPD (at the beginning of ECMO: 15.0±6.0 mm Hg vs.28.0±5.0 mm Hg, P=0.000; 24 hours later: 16.0±5.0 mm Hg vs. 30.0±7.0 mm Hg, P=0.000) and less thrombus formation(7.1% vs.23.1%, P=0.037), less plasma leakage (0.0% vs. 50.8%, P=0.000), less hemolysis (14.3% vs. 29.2%, P=0.047). There were no significant differences between the two groups in support duration, complication rate, and hospital mortality(Pgt;0.05). Conclusion Both devices have similar effects for safe clinical application, but Quadrox PLS ECMO system has a relatively high biocompatibility with lower TMPD, less plasma leakage, and thrombus formation.
Objective To summarize the clinical experiences of venoarterial extracorporeal membrane oxygenation (ECMO) which provides temporary cardiopulmonary assist for critical patients, and preliminary analysis of the cause of failure. Methods From February 2005 to October 2008, 58 adult patients (male 42, female 16) undergoing cardiogenic shock required temporary ECMO support. Age was 44.8±17.6 years, and support duration of ECMO was 131.9±104.7 hours. There were 24 patients (41.4%) with coronary heart disease, 11 patients (19.0%) with cardiomyopathy, 10 patients (17.2%) with cardiac valve disease,and 9 patients (15.5%) with congenital heart disease. Results 22 patients died in hospital. 11 patients (50%) died of multisystem organ failure, 5 patients (22.7%) died of refractory heart failure despite the ECMO support. Another patients died of bleeding and severe pulmonary hypertension etc. The percentage for patients need cardiac resuscitation before ECMO support and patients with acute renal failure treated by continuous renal replacement therapy (CRRT) under ECMO support were obviously higher in dead patients than those in survivor patients (45.5% vs.19.4%, 40.9% vs. 5.6%; P=0.043，0.001). All of the discharged patients were reassessed, mean followup time were 15.6 months. Three patients died of refractory heart failure， 1 patient died of neurologic complications. The other 32 survivors were in good condition with cardiac symptom of New York Heart Association class Ⅰ or Ⅱ. Conclusion ECMO offers effective cardiopulmonary support in adults. Early intervention and control of complications could improve our results with increasing experience. Combining using CRRT during the ECMO support is associated with significantly higher mortality rate. Suffered cardiac arrest prior to ECMO also influences the survival.