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Objective To compare the perioperative characteristics and long term outcomes between extracorporeal membrane oxygenation (ECMO)-conventional cardiopulmonary switch (experimental group,26 cases) and off-pump high-risk coronary artery bypass grafting (OPCABG group,24cases).Methods Perioperative characteristics and survival rate were retrospectively analyzed between experimental group and OPCABG group.Long term survival rates without major cardiovascular adverse events (MACE) were comparatively analyzed via Kaplan-Meier curves.Results The average Euroscore value were 11.7 ± 2.4 and 10.9 ± 2.0,respectively(P =0.208).The experimental group had a higher complete revascularization rate (96.2％ vs.66.7％,P =0.009),a shorter length of postoperative ECMO support [(33.1±23.6)h vs.(80.8±18.5)h],an intensive care unit stay[(4.8±1.1)d vs.(10.2±9.0)d]and a hospital stay [(17.7±6.3)d vs.(28.2±17.5)d] (all P＜0.05) as compared with OPCABG group.Preoperative New York Heart Association (NYHA) grading of cardiac function (r =0.511,P =0.008) and intraoperative ultrafiltration volume (r =-0.442,P =0.024) were significantly correlated with postoperative ECMO continuation in the experimental group.The follow-up period was (45.4 ± 15.2) months.The experimental group had a higher survival rate without MACE than had the OPCABG group (Log-rank test:x2=4.828,P=0.028).Conclusions The ECMO-conventional cardiopulmonary switch mode might facilitate a higher complete revascularization,a lower incidence of postoperative morbidities and improve the longterm survival rate without MACE for patients with high risks.
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Acute myocardial infarction (AMI) and acute massive pulmonary embolism can be characterized by no pulse electrical activity. Patients of cardiac arrest (CA) with no pulse electrical activity have a high mortality rate before the cause was corrected. Extracorporeal membrane oxygenation (ECMO), as a kind of artificial heart-lung support organ, provides treatment for CA patients. A case of massive pulmonary embolism similar to AMI was treated in the Third Central Hospital of Tianjin, who received interventional thrombolysis assisted by ECMO. Through the review of the overall development of the case, we aim to broaden the diagnosis and treatment of CA patients with no pulse electrical activity, and to improve the understanding of the complications secondary to ECMO.
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Acute myocardial infarction (AMI) and acute massive pulmonary embolism can be characterized by no pulse electrical activity. Patients of cardiac arrest (CA) with no pulse electrical activity have a high mortality rate before the cause was corrected. Extracorporeal membrane oxygenation (ECMO), as a kind of artificial heart-lung support organ, provides treatment for CA patients. A case of massive pulmonary embolism similar to AMI was treated in the Third Central Hospital of Tianjin, who received interventional thrombolysis assisted by ECMO. Through the review of the overall development of the case, we aim to broaden the diagnosis and treatment of CA patients with no pulse electrical activity, and to improve the understanding of the complications secondary to ECMO.
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Objective To summarize clinical application, method and result of extra-corporeal membrane oxygenation ( ECMO) used during beating heart coronary artery bypass grafting ( CABG) in high risk patients. Methods Twenty one patients [ mean age ( 75. 7 ± 3. 6 ) years old ] who received beating-heart CABG surgery assisted with ECMO were included in the study. We observed the condition when ECMO weaned off, the duration on mechanical rentilato time of ICU stay and the occurance of related complications. Results Among the 21 patients, ECMO was weaned off uneventfully after surgery in 8 patients. Immediate weaning was failed in another 8 patients and required gradual weaning in 2. 0-4. 5 hrs. Five patients could not wean off the ECMO in operation room needing continuous ECMO support in CCU. ECMO was weaned off in CCU gradually with IABP support [mean IABP support time: (115. 0 ± 25. 9) hrs]. Among the 5 patients admitted into CCU, 1 patient had oozing from insertion site at femoral artery/rein region and was stopped with compressive bandage. Lower limb ischemia happened in another 1 patient and was recovered after set up of by-pass circulation. All 21 patients recovered well and smoothly. Mean in-hospital stay was (17. 4 ± 2. 8) d. Conclusions ECMO is a safe and effective circulatory support during beating heart coronary artery bypass surgery for high-risk patients with severe coronary artery disease in reducing the mortality and complications.
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Objective To compare inter-hospital transport and clinical outcome in severe acute respiratory distress syndrome(ARDS)patients whom were transported either on extracorporeal membrane oxygenation(ECMO) or on conventional ventilation,and to investigate the optimal means of inter-hospital transport. Methods Eleven patients with severe ARDS who were invalid under conventional ventilation and were transported from other hospitals to Tianjin Third Central Hospital from November 2009 to January 2014 were analyzed. Five patients were transported on ECMO(observation group)and 6 on conventional ventilation(control group). The clinical characteristics,outcomes, transportation,vital signs before and after transportation,respiratory parameters,and Murray score between two groups were compared. Results Patients in observation group were significantly older than those in control group〔years:73(46,77)vs. 34(23,46),Z=-2.293,P=0.022〕. There was no significant difference between observation group and control group in acute pathologic and chronic health evaluationⅡ(APACHEⅡ)score,Murray score,oxygenation index(PaO2/FiO2)before transportation,transit time,and transit distance〔APACHEⅡscore:36(33,39)vs. 27(23,35),Z=-1.830,P=0.067;Murray score:3.5±0.3 vs. 3.4±0.2,t=0.667,P=0.524;PaO2/FiO2(mmHg, 1 mmHg=0.133 kPa):61±14 vs. 63±14,t=-0.249,P=0.809;transit time(minutes):24(18,74)vs. 79(41, 86),Z=-1.654,P=0.098;transit distance(km):12.9(8.3,71.8)vs. 72.4(39.5,86.8),Z=-1.651,P=0.099〕. There was no significant difference between two groups in vital signs and respiratory parameters before transportation. When arrived in ECMO centre,heart rate,respiratory rate,fractional inspired oxygen,inspiratory pressure and Murray score in observation group were significantly lower than those in control group〔heart rate(beat/min):102±16 vs. 136±8, t=-4.374, P=0.002;respiratory rate(beat/min):23±3 vs. 37±2,t=-7.967,P=0.000;fractional inspired oxygen:0.40±0.05 vs. 0.96±0.09,t=-12.152,P=0.000;inspiratory pressure(cmH2O, 1 cmH2O=0.098 kPa):21±1 vs. 34±4,t=-6.887,P=0.000;Murray score:2.7±0.2 vs. 3.8±0.2,t=-8.573, P=0.000〕,but PaO2/FiO2 was higher than that of control group(mmHg:278±65 vs. 41±5 ,t=8.075,P=0.001). Four patients were survived in observation group,and one died from the shortage of oxygen induced lung injury deterioration during transportation. Three patients died in control group,which was directly associated with lung injury deterioration. Conclusion For patients with severe ARDS who need the support of ECMO,ECMO-assisted transfer is safer than conventional ventilation,but transfer should be implemented by experienced team.
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10.3969/j.issn.2095-4344.2013.25.015
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Objective To prepare and evaluate the biocompatibility of polycarbonate coated with low molecular weight heparin (LMWH) and partial oxidation sodium alginate(OSA).Methods Coating material was prepared by means of chemical graft-modification and the feature of the material was determined with infrared spectrum and the stablity of the coating in fluid was examined.Biocompatibility was evaluated by contact angle and in-vitro tests including protein adhesion,platelet adhesion and caugulation.Results LMWH or OSA was tightly combined with polycarbonate.After being coated,the contact angle,albumin and fibrinogen adhering to materials were decrease (P＜0.05).The anticoagulant activity was notably promoted by coating.Compared with LMWH coated material,the contact angle,albumin and fibrinogen adhering were decreased significantly,but the improvement of anticaugulation was limited(P＜0.05).Conclusion Chemical graft-modification LMWH or OSA can be applied to polycarbonate.The biocompatibility of the coated materials was significantly promoted.
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Objective To summarize extracorporeal membrane oxygenation (ECMO) in percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) with cardiac arrest,and to evaluate the clinical efficacy comparing with literature review.Methods 5 patients of AMI with cardiac arrest who proved invalid to conventional cardio-pulmonaryresuscitation (CPR),were successfully resuscitated with ECMO support,and underwent emergency PCI with stable hemodynamic status.Results In support of ECMO,4 patients were successfully resuscitated with stable hemodynamic status,and underwent primary PCI.The duration of ECMO support ranged from 42 to 220 h (average 126.6 h).3 patients discharged with full recovery,one patient didn't wean from ECMO successfully,and one died of respiratory failure.Conclusion Although mortality of AMI with cardiac arrest is high,early ECMO-assisted cardiopulmonary resuscitation and secondary PCI treatment increase the possibility of cardiac recovery,and provide conditions for emergency revascularization treatment.This reduces mortality in critical patients with AMI,and is an effective short term life support method.
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Objective To summarize the method and effects of extracorporeal membrane oxygenation (EC-MO) for eight patients with sever heart or(and) lung diseases,and to get some reliable advises by analysis of retro-spoctive indications,timing and result in ECMO therapy. Methods Eight patients,aging from 26 to 82 and weighted from 57-87 kg were observed. Vein-artery ECMO was used in all patients,with the flow in 40-70 ml/(kg·min) and the activated clotting time(ACT) kept at 160-200 s. Results The time of ECMO support varied from 9.5 h to 84.1 h;Among the eight patients,one didn't weaned from ECMO and died,two who were weaned died 38 h ,6 h af-ter ECMO;five patients weanned succsesefully from ECMO and discharged. Conclusions ECMO do well in treat-ment of severe cardiopulmonary failure, resuscitation and support post cardiosurgery,and the indication and timing performance are important to the final result.
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Objective To investigate the method of cardiopulmonary bypass(CPB) for the repair of atrial septal defect with thoracoscopy. Methods Thirty-six patients with atrial septal defect were operated on.The artery channel and one venous channel were placed in the right femoral artery and femoral venous,the other venous channel was placed in the superior venous cave to set up CPB.The thoracoscope was put into thoracic cavity by the seventh interspace;the other two holes in the fourth interspace were used for operative procedure.The atrial septal defect was closed by thoracoscopy with the help of CPB. Results Except one patient whose incision was extended to stanch bleeding so as to avoid accidents when CPB stopped resulting in low oxygen saturation operation for other patients was successful.After operation,thirty-five patients recovered well and no complication occurred. Conclusions It is safe and reliable to repair atria septal defect with thoracoscopy with the help of CPB.