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CRITICAL CARE ECHO ROUNDS: Extracorporeal membrane oxygenation

机译：紧急护理回声：体外膜氧合

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Extracorporeal membrane oxygenation (ECMO) is an advanced form of organ support indicated in selected cases of severe cardiovascular and respiratory failure. Echocardiography is an invaluable diagnostic and monitoring tool in all aspects of ECMO support. The unique nature of ECMO, and its distinct effects upon cardio-respiratory physiology, requires the echocardiographer to have a sound understanding of the technology and its interaction with the patient. In this article, we introduce the key concepts underpinning commonly used modes of ECMO and discuss the role of echocardiography.CaseA 38-year-old lady, with no significant past medical history, was admitted to her local hospital with group A Streptococcal pneumonia. Rapidly progressive respiratory failure ensued and, despite intubation and maximal ventilatory support, adequate oxygenation proved impossible. She was attended by the regional severe respiratory failure service who established her on veno-venous (VV)-ECMO for respiratory support. Systemic oxygenation improved; however, significant cardiovascular compromise was encountered and echocardiography demonstrated a severe septic cardiomyopathy (ejection fraction 15%, aortic velocity time integral 5.9?cm and mitral regurgitation dP/dt 672?mmHg/s). Her ECMO support was consequently converted to a veno-veno-arterial configuration, thus providing additional haemodynamic support. As the sepsis resolved, arterial ECMO support was weaned under echocardiographic guidance; subsequent resolution of intrinsic respiratory function allowed the weaning of VV-ECMO support. The patient was liberated from ECMO 7 days after hospital admission.
机译：体外膜氧合作用（ECMO）是器官支持的一种高级形式，适用于某些严重的心血管和呼吸衰竭病例。超声心动图是ECMO支持各个方面的宝贵诊断和监测工具。 ECMO的独特性质及其对心脏呼吸生理的独特影响，要求超声心动图医师对这项技术及其与患者的相互作用有深入的了解。在本文中，我们介绍了支持ECMO常用模式的关键概念并讨论了超声心动图的作用。病例38岁的女士，既往无明显病史，因A链球菌性肺炎入院。随后发生快速进行性呼吸衰竭，并且尽管进行了插管和最大程度的通气支持，但仍无法进行充分的充氧。她参加了区域严重呼吸衰竭服务，并通过静脉-静脉（VV）-ECMO建立了呼吸支持服务。全身性氧合改善;但是，遇到了严重的心血管损害，超声心动图显示出严重的败血性心肌病（射血分数<15％，主动脉速度时间积分为5.9？cm，二尖瓣反流为dP / dt 672？mmHg / s）。她的ECMO支持因此被转换为静脉-静脉-动脉配置，从而提供了额外的血液动力学支持。败血症解决后，在超声心动图指导下撤消了动脉ECMO支持。内在呼吸功能的后续解决使VV-ECMO支持断奶了。入院后7天，患者从ECMO中解放出来。

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