重新定义ECMO插管:tee引导的VP ECMO和漂浮导管一例。

IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Daniel Manzur-Sandoval, Gian Manuel Jiménez-Rodríguez, Eduardo Bucio-Reta, Alejandro Sierra-González de Cossío, Jessy Steve Masso-Bueso, Gustavo Rojas-Velasco
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引用次数: 0

摘要

静脉肺ECMO (VP ECMO)是一种先进的支持策略,用于严重呼吸衰竭和右心室功能障碍患者,通过氧合血液和卸载右心室提供肺保护。本病例讨论了一名57岁女性,患有感染性心肌病、难治性心源性休克和ARDS,尽管常规治疗,但仍出现进行性呼吸恶化。由于患者不稳定,她被放置VP ECMO(股静脉引流肺动脉回输),完全由经食管超声心动图(TEE)引导。TEE的使用使肺动脉插管成功,无需透视引导。此外,还使用了一种漂浮导管来促进导丝的放置,提高了在这种紧急情况下的手术成功率。启动ECMO后,患者表现出明显的临床改善,右心室扩张和室间隔运动的矛盾得到解决。该病例强调了tee引导的VP ECMO的可行性和安全性,表明漂浮导管技术在危急情况下可能是有益的,值得进一步研究以建立临床指南。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Redefining ECMO cannulation: A case for TEE-guided VP ECMO and flotation catheter.

Venopulmonary ECMO (VP ECMO) is an advanced support strategy for patients with severe respiratory failure and right ventricular (RV) dysfunction, providing pulmonary protection by oxygenating blood and unloading the RV. This case discusses a 57-year-old female with septic cardiomyopathy, refractory cardiogenic shock, and ARDS, who developed progressive respiratory deterioration despite conventional treatment. Due to patient instability, she was placed on VP ECMO (femoral venous drainage and pulmonary artery reinfusion), guided exclusively by transesophageal echocardiography (TEE). The use of TEE enabled successful pulmonary artery cannulation without the need for fluoroscopic guidance. Additionally, a flotation catheter was used to facilitate guidewire placement, improving procedural success in this emergent situation. After initiating ECMO, the patient showed significant clinical improvement, with resolution of RV dilation and paradoxical septal motion. This case underscores the feasibility and safety of TEE-guided VP ECMO, suggesting that the flotation catheter technique could be beneficial in critical situations, warranting further investigation to establish clinical guidelines.

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来源期刊
Perfusion-Uk
Perfusion-Uk 医学-外周血管病
CiteScore
3.00
自引率
8.30%
发文量
203
审稿时长
6-12 weeks
期刊介绍: Perfusion is an ISI-ranked, peer-reviewed scholarly journal, which provides current information on all aspects of perfusion, oxygenation and biocompatibility and their use in modern cardiac surgery. The journal is at the forefront of international research and development and presents an appropriately multidisciplinary approach to perfusion science.
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