目的 分析股动静脉插管在体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）抢救治疗中的临床应用。方法 回顾性分析笔者所在医院2002 年6 月至2010年7 月期间因重症心肺功能衰竭而施行股动静脉插管并进行静脉-动脉转流体外膜肺氧合（VA-ECMO）抢救的47例患者的临床资料。结果 本组47例患者均顺利施行ECMO支持，37例患者经过治疗后治愈出院，10例死亡。插管并发症有出血、肢体缺血等，均经相应处理后治愈。结论 ECMO对急性心肺衰竭是理想的支持方法，股动静脉为急救插管的首选通道。
Objective To summarize and further investigate the initial experience of organ procurement process for organ donation after cardiac death （DCD）. Methods The clinical data，the selected standard，and the organ procurement process of 28 cases of DCD from July 2009 to January 2012 in the liver transplantation center of Guangzhou General Hospital were reviewed and analyzed. Results Twenty-eight cases of DCD all had donated organs successfully. Among these cases，there were 3 cases （10.7%） of the Maastricht Ⅲ， and one case （3.6%） of the Maastricht Ⅳ，and 24 cases （85.7%） of the organ donation after brain death plus cardiac death （DBCD）．Three cases of the Maastricht Ⅲ were practiced the organ procurement process of DCD．One case of the Maastricht Ⅳ was practiced the organ procurement process of DBCD without the extracorporeal membrane oxygenation （ECMO）．Twenty-four cases of DBCD were practiced the organ procurement process of DBCD with the ECMO．The donator warm ischemic time was zero min in DBCD，18 min in Maastricht Ⅳ，and mean 25 min （22-28 min） in MaastrichtⅢ．All the donated organs included 28 livers，40 kidneys，and 2 hearts．And all these organs had been practiced the liver transplantation，the kidney transplantation，and the heart transplantation. Conclusions The organ procurement process for organ DCD includes the DCD process and the DBCD process in China，and the later includes the organ procurement process with the ECMO and without the ECMO．The ECMO could well control the warm ischemia for protecting the donors just without ethics dispute. So，the using of the ECMO for the organ DCD of citizen in China has a very important contribution．
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.
Although the survival rate reported in each center is different, according to the present studies, compared to conventional cardiopulmonary resuscitation (CCPR), extracorporeal cardiopulmonary resuscitation (ECPR) can improve the survival rate of cardiac arrest patient, no matter out-of-hospital or in-hospital. The obvious advantage of ECPR is that it can reduce the nervous system complications in the cardiac arrest patients and improve survival rate to hospital discharge. However, ECPR is expensive and without the uniformed indications for implantation. The prognosis for patients with ECPR support is also variant due to the different etiology. If we want to achieve better result, the ECPR technology itself needs to be further improved.
Objective To explore the value of extracorporeal membrane oxygenation(ECMO) combined with hypothermia therapy for children patients with refractory cardiac arrest after congenital heart disease surgery. Methods From January 2013 to June 2016, we conducted a prospective study of 23 children (18 males, 5 females at age of 7±11 months) who underwent ECMO for refractory cardiac arrest after congenital heart disease surgery. All patients were randomly divided into two groups: a standard group (11 patients) and a hypothermia group (12 patients). The patients of the standard group received standard therapy (the core body temperature maintaining at 37.0℃) and the hypothermia group received hypothermia therapy (the core body temperature maintaining at 33.0℃). The hospital discharge rate, the rate of weaning from ECMO and the morbidity were compared between the two groups. Results Eleven of 23 patients (47.8%) were weaned from ECMO successfully and 7 of 23 patients (30.4%) discharged from hospital. The hospital discharge rate between the hypothermia group (n=6, 50.0%) and the standard group (n=1, 9.1%) had no statistical difference (χ2=4.537, P=0.069). The rate of weaning from ECMO of the hypothermia group (n=9, 75.0%) was higher than that of the standard group (n=2, 18.2%, χ2=7.425, P=0.006). The morbidity between the two groups had no statistical difference. Conclusion Extracorporeal cardiopulmonary resuscitation can improve the survival rate of the children who suffered from refractory cardiac arrest after congenital heart disease surgery. There is no evidence that ECMO combined with hyperthermia therapy is better than the only ECMO in improving the discharge rate. But ECMO combined with hypothermia therapy has higher rate of weaning from ECMO than that of the only ECMO.