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ABSTRACT Objective: To explore the factors affecting short-term prognosis of circulatory failure patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) treatment. Methods: A total of 136 patients undergoing VA-ECMO were enrolled in this study and subsequently divided into the death group (n=35) and the survival group (n=101) based on whether death occurred during hospitalisation. Extracorporeal membrane oxygenation (ECMO) running time, length of intensive care unit stay, length of hospital stay, costs, and ECMO complications were then compared between the two groups. Results: The average age of all patients undergoing ECMO was 47.64±16.78 years (53.2±16.20 years in the death group and 45.713±16.62 years in the survival group) (P=0.022). Patients in the survival group exhibited a clear downward trend in lactic acid value following ECMO treatment compared to those in the death group. Total hospitalisation stay was longer in the survival group (35 days) than in the death group (15.5 days) (P<0.001). In the analysis of ECMO complications, the incidence of neurological complications, renal failure, limb complications, and infection were higher in the death group than in the survival group (P<0.05 for all). Specifically, as a risk factor for patient survival and discharge, the occurrence of infection will lead to increased hospitalisation stays and costs (P<0.05 for both). Conclusion: Complications such as kidney failure and infection are associated with in-hospital death, and ECMO-related complications should be actively prevented to improve the survival rate of VA-ECMO treatment.
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【Objective】 To analyze the blood transfusion strategies in extracorporeal membrane oxygenation (ECMO) recievers in our hospital, so as to explore the clinical application and efficacy of blood transfusion in patients on ECMO. 【Methods】 Data from patients on ECMO treatment in our hospital from October 2017 to October 2021 was collected. The blood transfusion data and coagulation monitoring indexes during different ECMO modes were analyzed, and the efficacy of blood transfusion was evaluated. 【Results】 No difference in the number of blood transfusions was noticed by ECMO treatment modes.The transfusion units of red blood cells, plasma and platelets in VA mode were (28.35±14.60) U, (7 367.78±5 194.33) mL and (7.04±5.10) therapeutic volumes, which were higher than those in VV mode, i. e. (18.67±21.50) U, (4 836.67±6 640.50) mL and (3.60±7.47) therapeutic dose, respectively.In VA-ECMO mode, the Hb level and platelet count before ECMO treatment were (126.44±23.9) g/L and (223.84±67.62) × 109/L, which were significantly higher than those after treatment (91.02±21.48) g/L and (172.86±127.73)×109/L.In VV-ECMO mode, the APTT before ECMO treatment was (35.28±8.73) s, which was shorter than that after treatment (41.96±13.69) s. The levels of fibrinogen, Hb and platelet count were (3.80±1.85) g/L, (123.81±33.77) g/L and (175.72±98.91)×109/L, which were significantly higher than the levels after treatment (2.78±1.08) g/L, (92.31±17.38) g/L and (125.31±98.14)×109/L, respectively. 【Conclusion】 There are differences in the amount of blood transfusion among different modes of ECMO treatment. As blood transfusion is a necessary support to ensure ECMO treatment, the monitoring of coagulation index is conducive to reduce blood transfusion, improve the efficiency of blood transfusion and benefit to patient safety.
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Objective To analyze the clinical and epidemiological characteristics of severe hand-foot-mouth disease (HFMD) complicated with heart failure in children, and to explore the risk factors of severe complications. Method The clinical data of children with HFMD admitted from January 2014 to December 2014 were retrospectively analyzed and their HFMD was at clinical stage 2 or over. Results There were totally 321 cases of severe HFMD, in which common group (clinical stage 2) had 306 cases and cardiopulmonary failure group (clinical stage 3 or 4) had 15 cases. There was no death in common group, while 7 cases died in cardiopulmonary failure group, and there was statistical difference (P<0.001). The median age in cardiopulmonary failure group was 9 months (6-20 months), which was lower than that in common group (median age of 24-month-old, 3 months to 12 years) and there was statistical difference (P<0.01). The peak temperature and fever duration were (39.44±0.23)℃, (5.01±0.94) d respectively in cardiopulmonary failure group, both of which were higher than peak temperature of (39.12 ±0.20)℃ and fever duration of (3.93 ± 0.47) d in common group, and the differences were significant (P all<0.05). The incidences of vomit, disturbance of consciousness, peripheral circulation, respiratory rhythm irregular and pneumonedema in cardiopulmonary failure group were higher than those in common group, and there were statistically significant differences (P all<0.001). The positive rate of human enterovirus 71 (EV71) in cardiopulmonary failure group was 85.7%, which was higher than that in common group, and there was significant difference (P<0.01). The levels of N terminal brain natriuretic peptide (NT-pro BNP) in cardiopulmonary failure group were all increased (100%), the rate of which was higher than that in common group (35.3%), and there was significant difference (P<0.001). Conclusion For children with HFMD, vomiting, consciousness disorders, circulatory disorders, respiratory rhythm disorders, EV71 positive and elevated levels of NT-pro BNP were risk factors of cardiopulmonary failure, and disease changes should be closely monitored.
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Objective To analyze the clinical value of continuous veno-venous hemofiltration (CVVH) treatment in children with severe hand-foot-and-mouth disease(HFMD) complicated with cardiopulmonary failure,via the prognostic comparison of the general comprehensive treatment and CVVH add-on treatment.Methods Fifty-one cases of severe HFMD with cardiopulmonary failure were divided into a CVVH group (n =19) and a control group(n =32) based on whether CVVH add-on or not.Their physiological and biochemical indicators were recorded and pediatric critical illness score (PCIS) and pediatric risk of mortality score (PRISM Ⅲ) were calculated within 24 hours,when they were diagnosed with neurogenic pulmonary edema (NPE)/pulmonary hemorrhage.Both groups were treated with endotracheal intubation,mechanical ventilation with high PEEP,corticosteroids,ulinastatin,actively lowering the intracranial pressure,fluid resuscitation,milrinone,dopamine and other vasoactive drugs,high-dose intravenous gamma globulin,the CVVH group were added with CVVH treatment(duration ＞ 12 h).Prognosis difference of CVVH add-on treatment after diagnosed with NPE/pulmonary hemorrhage by tracking indicators of the third day.Survival analysis between two groups were compared by 3-day survival rates,7-day survival rates,28-day survival rates and the finally survival rates.Results (1) The overall conditions of two groups were comparable when diagnosed with NPE/pulmonary hemorrhage.PCIS,PRISM Ⅲ,WBC counting,lactic acid,micro-blood sugar,myocardial enzymes and liver enzymes showed no significant difference between two groups.Three days after treatment,WBC and lactic acid decreased,but there was no significant difference (P ＞ 0.05),the remaining indicators had significantly improved in the CVVH group than those in the control group (P ＜ 0.05).(2) The 3-day survival rate,7-day survival rate,28-day survival rate and the finally survival rates in control group and CVVH group were 40.63 ％ vs.84.21％,37.50％ vs.73.68％,25.00％ vs.63.16％,18.75％vs.52.63％,the survival rate in CVVH group were significantly higher(P ＜0.05).(3)The survival curve indicated that the survival time of CVVH group was significantly longer than that of the control group,the median survival time were 17 d and 2 d,respectively,and the difference was statistically significant (P ＜ 0.05).(4)In the CVVH group,15 cases received CVVH after diagnosed with NPE/pulmonary hemorrhage within 12 hours,of which 10 cases(66.67％) ultimately survived,while the other 4 cases received CVVH after 12 h were all end to death,the difference was statistically significant(P ＜ 0.05).Further analysis of the impact of the timing of blood purification on the prognosis of children showed that the mortality rates of children received CVVH within 6 hours,6 to 12 hours,after 12 hours of diagnosis of NPE/pulmonary hemorrhage,were 2/8,3/7,4/4,respectively.Conclusion Continuous hemofiltration can significantly improve the prognosis of children with severe HFMD,and may be preferable to perform in early stage.
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Objective To investigate the curative effect of sodium nitroprusside in the treatment of EV71-related pneumoedema/pneumorrhagia and hypotension in this study. Methods This was a retrospective study of a total 10 children with EV71-related pneumoedema/pneumorrhagia treated with sodium nitroprusside using case-control methods. The clinical manifestations and outcomes of the 10 children (present cohort) were compared with those of 8 children (past cohort) who had EV71-related pneumoedema/pneumorrhagia without sodium nitroprusside. Results Among these 10 patients,all were at the appearance of pneumoedema/pneumorrhagia, cardiac arrhythmia and hypotension. Two patients showed severe cardiac arrhythmia, two patients showed cardiac arrest for many times. All 10 patients were treated with mechanical ventilation and other conventional treatments. At the first time of the manifest of hypotension,sodium nitroprusside were put into practice in all 10 patients. Ten patients were treated with intravenously sodium nitroprusside in the stage of hypotension by maxi30 min ～ 1 h,the patients showed an improvement in vultus,pulse and peripheral circulation and decrease of heart rate and elevation of blood pressure after 30 min ～2 h,but at least 2～6 h later,the blood pressure tended to stabilize at normal standard. Conclusion Hypotension is the intensive stage in EV71-related hand,foot and mouth disease ,and the shock syndrome caused by acute left ventricular disorder is related to sympathetic nerve activity. Sodium nitroprusside can effectively reduce the cardiac afterload,and correct shock and improve the prognosis.
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Objective To summarize the clinical experiences in setting up cardiopulmonary bypass(CPB)using extracorporeal membrane oxygenation(ECMO)circuit and turning CPB to ECMO after open heart operations in 16 cases.Methods In the group of 16 cases,the annulations were via femoral vessels:by Medtronic ECMO machine and membrane oxygenator was used in all patients.All patients accepted A-V bypass.Results CPB was running smoothly during the operations,and converted to ECMO after the surgeries without complications,and the rate of ECMO withdraw was 93.75%.Mortality was 18.5%,and 81.25%of patients were discharged.Conclusion ECMO is an effective device for cardio and pulmonary support.Many patients with severe cardiac diseases and marginal cardiac function will need mechanical support after surgery.For these patients,setting up CPB using ECMO circuit during the operation and converting it to ECMO after surgery can prevent patients from additional exposure to a standard CPB circuitry.It helps decrease the inflammatory response,avoid dilution of patient's volume of cells and factors,and reduce expenses.