Emergent Application of Extracorporeal Membrane Oxygenation in Patients Unresponsive to Cardiopulmonary Resuscitation

緊急葉克膜使用於心肺復甦患者

胡珀元(Po-Yuan Hu) ； 吳毅暉(I-Hui Wu) ； 李君儀(Jiun-Yi Lee) ； 陳益祥(Yih-Sharng Chen) ； 柯文哲(Wen-Je Ko) ； 林芳郁(Fang-Yue Lin) ； 王水深(Shoei-Shan Wang)

《中華民國急救加護醫學會雜誌》 12卷2期 (2001/06) Pp. 55-62

https://doi.org/10.30018/JECCM.200106.0002

摘要

葉搭膜在對於緊急心肺復甦術無反應的患者扮演了相當重要的角色，因為它能立即提供充分的心臟及肺臟支持。從1995年1月到2000年1月，有35個患者在緊急心復甦術後裝置葉克膜，適應症包括在經過10分鐘之胸廓外心臟按摩，及超過5毫克之腎上腺素注射，仍無法回復自發性心跳或血液循環，所有病人均採行股動脈，股靜脈置入，及使用離心式幫浦。患者平均年齡49.6 ± 12.4歲，疾病人布包括16個急性心肌梗塞，8個擴張性心肌病變，4個肺栓塞，3個人工心臟瓣膜栓塞，3個急性心肌炎，與1個換心後發生急性排斥。16個病人在裝置葉克膜後，接受進一步的處置治療，共16個病人成功脫離葉克膜，共7個病人存活。總之，如果患者本身的疾病是可治療改善，或利用外科手術矯正，則存活的可能性較大。因此審慎的選擇病人，且儘早裝置葉克膜有助於提升存活率。

並列摘要

Background: We attempted to identify the effect of extracorporeal membrane oxygenation (ECMO) in patients unresponsive to emergent cardiopulmonary resuscitation (CPR).
Materials and Methods: Between January 1995 and January 2000, 35 unresponsive to conventional CPR patients were rescued by ECMO in our institute. The indication for emergent application of ECMO was the inability to resume a spontaneous heart beat or circulation after 10-min closed chest external cardiac massage and/or injection of more than 5 mg of epinephrine. Femoral venoarterial perfusion was achieved in all patients using a centrifugal pump, heparin-bonded cannulas, and a hollow-fiber oxygenator. Clinical date of these patients are reviewed.
Results: The average age was 49.6± 12.4 years. Underlying disease leading to ECMO support included acute myocardial infarction ^(16), dilated cardiomyopathy ^(8), pulmonary embolism ^(4), prosthetic valve thrombosis ^(3), acute myocarditis ^(3), and acute rejection of a transplanted heart ^(1). ECMO allowed additional therapeutic intervention in 16 patients (45.7%). Weaning from ECMO was successful in 16 patients (45.7%); 7 patients (20%) survived and were discharged. Five of the 7 patients who survived had major therapeutic intervention after ECMO support.
Conclusions: Patients with a surgically correctable or reversible disease were more likely to survive. Appropriate patient selection and early application of ECMO may lead to improved survival.