[Venoarterial extracorporeal membrane oxygenation: from evidence to clinical practice].

IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Luigi Oltrona Visconti, Rita Camporotondo, Marco Ferlini, Simone Savastano, Ginevra Annoni, Alessandro Fasolino
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引用次数: 0

Abstract

Mortality for cardiogenic shock is still high despite optimal pharmacological therapy. Therefore, active mechanical circulatory support devices are increasingly used; venoarterial extracorporeal membrane oxygenation (VA-ECMO) enables full circulatory and respiratory support. However, recent data show that in patients with infarct-related shock unselected early use of VA-ECMO does not improve survival and is associated with major bleeding and peripheral ischemic complications. Nowadays, waiting for the results of definitive randomized controlled trials, the main indication for ECMO utilization is in selected patients with cardiac arrest, in those with shock for advanced heart failure refractory to conventional therapy, in those with fulminant myocarditis, in patients candidate for heart transplant or ventricular assistance, especially in presence of respiratory insufficiency and severe biventricular dysfunction. An important recommendation is its utilization in specialized, high-volume centers in the setting of hub and spoke hospitals.

[静脉体外膜肺氧合:从证据到临床实践]。
尽管采用了最佳的药物治疗,心源性休克的死亡率仍然很高。因此,主动式机械循环支持装置的使用越来越多;静脉体外膜肺氧合(VA-ECMO)可实现全面的循环和呼吸支持。然而,最近的数据显示,在梗死相关休克患者中,未经选择的早期使用 VA-ECMO 并不能提高存活率,反而会导致大出血和外周缺血并发症。目前,在等待明确的随机对照试验结果的同时,ECMO 的主要适应症是经过选择的心脏骤停患者、常规治疗难治的晚期心衰休克患者、暴发性心肌炎患者、心脏移植或心室辅助的候选患者,尤其是存在呼吸功能不全和严重双心室功能障碍的患者。一项重要的建议是,在枢纽医院和辐条医院的背景下,在专业化、高容量中心使用该疗法。
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来源期刊
Giornale italiano di cardiologia
Giornale italiano di cardiologia CARDIAC & CARDIOVASCULAR SYSTEMS-
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