The first case of severe avian influenza A (H7N9) in Guangdong Province in 2018 successfully treated with extracorporeal membrane oxygenation / 中华危重病急救医学

Human infection with avian influenza A (H7N9) is easy to induce severe acute respiratory distress syndrome (ARDS), and traditional mechanical ventilation cannot correct hypoxemia, so patients may die from multiple organ failure (MOF) caused by persistent hypoxia. Extracorporeal membrane oxygenation (ECMO) can provide effective respiratory support and win time for the treatment of severe H7N9. The first case of severe H7N9 in Guangdong Province in 2018 was admitted to Zhongshan Hospital Affiliated to Sun Yat-sen University. The case was insult with severe ARDS caused by H7N9, the traditional mechanical ventilation could not correct hypoxemia, and the lung condition gradually improved with ECMO assistance. After 13 days of ECMO support, the patient was successfully weaned from ECMO and was transferred to a general ward after 55 days. After 102 days of rehabilitation, the patient was discharged from hospital and followed up for 2 months, who was in good health and had a good quality of life. This article states the diagnosis and treatment of severe H7N9 in details, providing experience for the treatment of severe H7N9 in the future.

Risk factors analysis of acute renal failure in patients with ECMO / 临床麻醉学杂志

Objective To explore the risk factors of acute renal failure (ARF)in patients with ECMO.Methods Retrospective analysis the patients with ECMO.There were 91 males and 79 fe-males.The age was 18-73 years old.Data of patients'preoperative basic situation(gender,age, history of related diseases,including hypertension,diabetes,heart history),related clinical situations during ECMO period,complications were collected.Patients were divided into two groups according to the ARF occurring.We selected the risk factors which may affect the ARF through the single factor analysis,and then determined the independent risk factors that affected the ECMO ARF by lo-gistic regression analysi.Results This study included 170 cases,91 cases occurred ARF (53.5%). Single factor analysis:the patient with CPR before ECMO,high lactic acid levels pre-ECMO,high inotropic equivalents,large amounts of red blood cells,plasma and platelet transfusion,high C-reac-tive protein levels and high BNP levels during ECMO,long time of ECMO support were associated with patients with ARF.Multiple factors analysis showed that high lactic acid levels pre-ECMO (OR 2.96,95% CI 1.38-6.34),P=0.005),high inotropic equivalents (OR 3.17,95% CI 1.52-6.61, P=0.002)were independent risk factors of ARF in patients with ECMO.Conclusion The patients with ECMO have a high incidence of acute renal failure,large doses of positive inotropic drug and high lactic acid levels are independent risk factors of acute renal failure in patients with ECMO.

Clinical application of extracorporeal membrane oxygenation for treatment of adult acute respiratory distress syndrome / 中国中西医结合急救杂志

Objective To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) treatment for adult acute respiratory distress syndrome (ARDS) caused by lung infections,so as to explore the clinical efficacy and application value of ECMO.Methods The patients with 7 ARDS who were responded poorly to mechanical ventilation in Zhongshan Affiliated Hospital of Sun Yat-sen University from January 2003 to January 2015 were collected.All patients were divided into a study group (7 cases) treated by ECMO and a control group (7 cases) treated by traditional methods.The percutaneous incision on femoral vein-internal jugular vein (V-V) was selected to carry out ECMO intubation,and the V-V ECMO model was used for auxiliary bypass of flow.The comparisons between the two groups for the results of hemodynamics,blood-gas analysis and oxygen metabolism were performed to evaluate synthetically the adjuvant effects of ECMO.Results Seven ARDS patients caused by lung infections were treated by ECMO,including 4 cases with bacterial pneumonia,2 cases with H7N9 and 1 case with H1N1.Thc duration of ECMO was (21.00 ± 10.06) days;2 cases were weaned from ECMO successfully,and 1 case recovered and discharged.Seven cases with ARDS caused by severe lung bacterial infections in control group were all not recovered on discharge.After treatment,the heart rate (HR),pulmonary arterial wedge pressure (PCWP),venous partial pressure of oxygen (PvO2),arterial blood lactic acid (Lac) in study group were significantly lower than those in the control group [HR (bpm)was 100± 12 vs.120± 19,PCWP (mmHg,1 mmHg =0.133 kPa) was 8.8 ± 2.6 vs.11.6± 3.8,PvCO2 (mmHg) was 40.8 ± 13.1 vs.48.9 ± 16.2,Lac (mmol/L) was 2.1 ± 0.8 vs.5.2 ± 0.6,all P ＜ 0.05],the mean arterial pressure (MAP),cardiac output index (CI),arterial and venous blood pH values,arterial partial pressure of oxygen (PaO2),arterial partial pressure carbon dioxide (PaCO2),arterial oxygen saturation (SaO2),oxygen delivery (DO2),oxygen consumption (VO2),oxygen extraction (ERO2) were obviously higher in study group than those control group [MAP (mmHg) was 83.6 ± 8.2 vs.72.2 ± 94,CI (mL· s-1 · m-2) was 93.35 ± 3.33 vs.81.68 ± 8.33,pH of arterial blood was 7.4 ± 0.1 vs.7.1 ± 0.3,PaO2 (mmHg):98.5 ± 20.4 vs.49.3 ± 12.6,PaCO2 (mmHg):38.9 ± 16.2 vs.26.1 ± 17.4,SaO2:0.95 ± 0.02 vs.0.58 ± 0.04,pit of venous blood was 7.1 ± 0.2 vs.6.4 ± 0.3,PvCO2 (mmHg) was 40.8 ± 13.1 vs.48.9 ± 16.2,SvO2 was 0.75 ± 0.07 vs.0.49 ± 0.08,DO2 (mL· min-1 · m-2) was 651 ± 36 vs.400 ± 81,VO2 (mL· min-1 · m-2) was 245.0 ± 11.2 vs.103.0 ± 14.8,ERO2 was (35.6± 3.9)％ vs.(21.3± 5.2)％,all P ＜ 0.05].Conclusions ECMO can improve hypoxemia.So it can improve the metabolism and maintain hemodynamic stability,in the mean time the patients may gain more time for diagnosis and treatment of their primary lung diseases.The key points of a successful ECMO are suitable selection of patients and forceful prevention of complications.

Ultrasound monitoring the renal blood flow during extracorporeal membrane oxygenation / 中国医师杂志

Objective To investigate the utilization of ultrasound monitoring the renal blood flow during extracorporeal membrane oxygenation (ECMO).Methods Twentry one cases,who received veinartery ECMO for heart failure,were examinated by bed-side ultrasound before the ECMO initiated,right after the ECMO initiated,each day after the ECMO initiated,and right after the ECMO weaned.The renal interlobar artery peak velocity (Vmax) was measured,and the renal interlobar artery resistant index (RI) was calculated,as well as the values of the serum creatinine (SCr) and blood urea nitrogen (BUN) were recorded.All the data were compared.Results Compared to the variables right after the ECMO initiated,thc Vmax incrcascd (P ＜ 0.05) two days after ECMO initiated and right after the ECMO weaned,while RI (P ＜ 0.05),SCr (P ＜ 0.05) and BUN (P ＜ 0.05) decreased,there being significant differences (P ＜ 0.05).Conclusions While treating patients with extracorporeal membrane oxygenation,the ultrasound can monitoring the renal blood flow effectively,and provide important parameters for the clinical doctors as the basis of the diagnosis and treatment.

Meta-analysis of Misoprotol Combined with 10% Calcium Gluconate Injection in the Treatment of Postpar-tum Hemorrhage / 中国药房

OBJECTIVE:To systematically review the efficacy and safety of misoprostol combined with 10% Calcium gluco-nate injection in the treatment of postpartum hemorrhage,and provide evidence-based reference for the clinical treatment. METH-ODS:Retrieved from PubMed,EMBase,Ovid,CBM,CJFD and VIP,randomized controlled trials (RCT) about misoprostol combined with 10% Calcium gluconate injection (test group) versus conventional oxytocin in the treatment of postpartum hemor-rhage were collected. Meta-analysis was performed by using Rev Man 5.2 software after data extract and quality evaluation by Co-chrane systematic review manual 5.1.0. RESULTS:Totally 7 RCTs were enrolled,involving 1254 pregnant women. Results of Me-ta-analysis showed,compared with conventional oxytocin,misoprostol combined with 10% Calcium gluconate injection can signifi-cantly reduce 2 h postpartum hemorrhage [MD=-76.76,95%CI(-105.73,-47.79),P<0.001],24 h postpartum hemorrhage [MD=-118.28,95%CI(-167.78,-68.78),P<0.001] and the incidence of postpartum hemorrhage [OR=0.19,95%CI(0.08, 0.46),P<0.001],and shorten the 3rd delivery process [MD=-3.52,95%CI(-4.20,-2.84),P<0.001],the differences were sta-tistically significant;there was no significant difference in the intraoperative hemorrhage [MD=-61.31,95%CI(-121.98,-0.64), P=0.05] and neonatal 1 min Apgar score [MD=0.10,95%CI(-0.38,0.59),P=0.67] in 2 groups. The incidences of chest dis-tress,breathlessness and stomach discomfort in test group were significantly higher than control group [OR=18,95%CI(2.42, 133.98),P=0.005],but it was mild,and there was no significant difference in the incidence of fver,chills and nausea,vomiting, diarrhea and other adverse reactions. CONCLUSIONS:Both the efficacy and safety of misoprostol combined with 10% Calcium gluconate injection in the treatment of postpartum hemorrhage are good. Due to low quality and small-scale of included studies, more large-scale and long-term follow-up studies with strict designed are required for further validation of the conclusions.

Intracoronary abciximab administration for patients undergoing percutaneous coronary intervention:a meta-analysis of randomized trials / 重庆医学

Objective To systematically evaluate the efficacy and safety of intracoronary abciximab administration as compared to intravenous in percutaneous coronary intervention (PCI) .Methods A search was conducted in PubMed ,EMBASE ,OVID ,CBM , CNKI and VIP for the randomized controlled trials (RCTs)of intracoronary abciximab administration versus intravenous in PCI , from the date of their establishment to September 30 ,2013 ,and the domestic relevant papers published in recent 1 year were also searched manually ,the bibliographies of the included studies were searched too .According to the criteria of the cochrane Hand-book ,two reviewers evaluated the quality of the included RCTs and extracted data independently ,and then the extracted data were analyzed by using RevMan 5 .1 software .Results 8 RCTs involving 10 articles with 4 150 patients who treated with PCI were in-cluded .The results of meta-analysis showed that :(1) Compared intravenous administration and intracoronary abciximab administra-tion ,there were no significant differences in the two groups for the major adverse cardiovascular event (MACE) and the mortality (OR=0 .78 ,95% CI 0 .54-1 .14 ,P=0 .20) ,(OR=0 .56 ,95% CI 0 .24-1 .30 ,P=0 .18) .(2)Compared with intravenous adminis-tration ,intracoronary abciximab administration were not associated with any excess of major bleeding complications :(OR=1 .26 , 95% CI 0 .78-2 .02 ,P=0 .35) .Conclusion Compared with standard abciximab regimen of intravenous bolus ,intracoronary admin-istration had equivalent effects in clinical outcomes in patients undergoing PCI ,and did not increase the incidence of bleeding events .

Effect of ulinastatin for hepatoprotection following extracorporeal membrane oxygenation / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the effect of ulinastatin in hepatoprotection following extracorporeal membrane oxygenation (ECMO).</p><p><b>METHODS</b>Forty patients with ECMO were randomized into two groups to receive ulinastatin treatment or not. Venous blood samples were collected to test ALT and AST levels following ECMO treatment for 12, 24 and 48 h.</p><p><b>RESULTS</b>The two groups showed no significant difference in liver function indices before ECMO treatment. In both groups, the liver function worsened significantly after a 12-h ECMO treatment, but improved gradually after 24 h. The liver function damages were obviously lessened in ulinastatin group compared to those in patients without ulinastatin treatment (P<0.05). ECMO treatment significantly improved the liver function of the patients.</p><p><b>CONCLUSION</b>ECMO can significantly improve the liver function. The liver function damage reaches the peak level after a 12-h ECMO treatment, and ulinastatin can protect the liver function in patients undergoing ECMO.</p>

Risk factors affecting the prognosis of adult cardiogenic shock patients treated with extracnrporeal membrane oxygenation / 中华急诊医学杂志

Objective To find out risk factors affecting the prognosis of adult cardiogenic shock patients treated with extracorporeal membrane oxygenation.Methods From January 2003 to December 2010,patients with cardiogenic shock required veno-arterial ECMO after failure of conventional therapy and intra-aortic balloon pump counterpulsation therapy were retrospectively studied. Patients with severe traumatic brain injury,advanced malignancies and multiple organ failure were excluded.All patients were divided into survival group and death group.The risk factors were found out using one-way ANOVA and a multivariate logistic regression analysis was used to determine independent factors associated with survival.Results Thirty-one patients successfully weaned from ECMO. Twenty-two patients were successfully discharged.The average duration of ECMO was 41.56 ± 43.07 hours.Factors associated with failure of hospital discharge were age,pre-ECMO levels of ejection fraction,pre-ECMO levels of lactate,disseminated intravascular coagulation,renal failure and multiorgan failure (P ＜ 0.05). Conclusions Irreversible heart failure and the complications are significantly correlated with survival,and the early use of ECMO for cardiogenic shock and recognize the factors are key to the success of ECMO treatment.

Application of extracorporeal membrane oxygenation to cardiopulmonary cerebral resuscitation / 中华急诊医学杂志

Objective To investigate the effects and values of extracorporeal membrane oxygenation (EC-MO) used in patients after cardiac arrest. Method During five years period from June 2002 to June 2007,fifteen cases taken for cardiopulmonary resuscitation were treated by using ECMO in the emergency department and ICU. All the measures for disgnosis and treatment were observed to the guidelines for cardiopulmonary resuscitation and emergency cardiovasculat care set by the American Heart Association in 2005, and ECMO was applied in addition. The study was a self-comparison trial. The biomarkers including heart rate (HR), mean arterial pressure (MAP), central venous pressure( CVP) , arterial partial oxygen pressure (PaO2), arterial partial pressure of carbon dioxide ( PCQ2), oxygen saturation (SaO2), hydrogen power (PH), and concentration of lactic acid were taken and assayed before and 10 min, 1 h,6 h, 12 h, and 24 h after treatment. Differences between the results of measurements were analysed by t -test for matched pairs using SPSS version 10.0 software package. Neurological sequelae was also observed and described. Results Ten minutes after ECMO treatment, MAP rose dramatically (P < 0.01) and got to further higher level one hour later ( P < 0.05). On the other hand, CVP dropped off 10 minutes after ECMO treatment and further lowered one hour later, and PaO2 and SaO2 were improved apparently ( P < 0.01), and pH was increased significantly (P < 0.01), while a derease in concentration of arterial LA of significantly (P < 0.01). Of the 15 cases, 11 patients got well,including completely recovered without sequelae in 5,memory disorders in 2 and hemipleggia in 2 patients. Conclusions ECMO provides effective blood flow to hearts, and therefore, improves oxygenation and oxygen consumption greatly. Moreover, it provides stable oxygenated blood to brain and therefore, it is a good approach to cardiopulmonary cerebral resuscitation.

Application of extracorporeal membrane oxygenation in patients with acute respiratory distress syndrome / 中国医师进修杂志

Objective To evaluate the effect of extracorporeal membrane oxygenation(ECMO) for critical acute respiratory distress syndrome(ARDS).Methods Twenty-two patients with critical ARDS were treated with ECMO after failure of conventional ventilation therapy.The PaO_2,PaCO_2,DO_2,VO_2 and hemodynamic parameters were retrospectively analysed.Result PaO_2,DO_2,VO_2 was improved significantly after ECMO.Sixteen patients survived.Conclusion Whenever other treatments fail to improve PaO_2 on critical ARDS patients,ECMO should be considered.

Clinical Study of Acute Hypervolemic Hemodilution on Meningioma Operation / 中国医师杂志

Objective To observe the clinical application of acute hypervolemic hemodilution (AHH) on patients undergoing surgical resection meningioma and the effects on the reduction of heterologous blood transfusion. Methods 40 scheduled mengingioma surgical patients were randomly divided into group I (AHH, n =20) and group II (control, n =20). All patients had same general anesthetic techniques. Amounts of heterologous blood transfusion and changes of postoperative hemoglobin in two group's were recorded and compared. Results BZ In AHH group 15 patients had no heterologous blood transfusion, 5 patients had 200～400 ml heterologous blood transfused. In control group all patients had 400～800ml heterologous blood transfused. Conclusion Acute hypervolemic hemodilution can significantly reduce the volumes of heterologous blood transfusion in mengingioma surgical patients.