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首页> 外文期刊>Critical care : >Extracorporeal life support devices and strategies for management of acute cardiorespiratory failure in adult patients: a comprehensive review
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Extracorporeal life support devices and strategies for management of acute cardiorespiratory failure in adult patients: a comprehensive review

机译：体外生命支持设备和成年患者急性心肺衰竭治疗策略：综述

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Evolution of extracorporeal life support (ECLS) technology has added a new dimension to the intensive care management of acute cardiac and/or respiratory failure in adult patients who fail conventional treatment. ECLS also complements cardiac surgical and cardiology procedures, implantation of long-term mechanical cardiac assist devices, heart and lung transplantation and cardiopulmonary resuscitation. Available ECLS therapies provide a range of options to the multidisciplinary teams who are involved in the time-critical care of these complex patients. While venovenous extracorporeal membrane oxygenation (ECMO) can provide complete respiratory support, extracorporeal carbon dioxide removal facilitates protective lung ventilation and provides only partial respiratory support. Mechanical circulatory support with venoarterial (VA) ECMO employed in a traditional central/peripheral fashion or in a temporary ventricular assist device configuration may stabilise patients with decompensated cardiac failure who have evidence of end-organ dysfunction, allowing time for recovery, decision-making, and bridging to implantation of a long-term mechanical circulatory support device and occasionally heart transplantation. In highly selected patients with combined severe cardiac and respiratory failure, advanced ECLS can be provided with central VA ECMO, peripheral VA ECMO with timely transition to venovenous ECMO or VA-venous ECMO upon myocardial recovery to avoid upper body hypoxia or by addition of an oxygenator to the temporary ventricular assist device circuit. This article summarises the available ECLS options and provides insights into the principles and practice of these techniques. One should emphasise that, as is common with many emerging therapies, their optimal use is currently not backed by quality evidence. This deficiency needs to be addressed to ensure that the full potential of ECLS can be achieved.
机译：体外生命支持（ECLS）技术的发展为常规治疗失败的成年患者的急性心脏和/或呼吸衰竭的重症监护管理增加了新的维度。 ECLS还补充了心脏外科手术和心脏病学程序，长期机械心脏辅助设备的植入，心脏和肺移植以及心肺复苏。可用的ECLS疗法为参与这些复杂患者的时间紧迫护理的多学科团队提供了多种选择。静脉静脉体外膜氧合（ECMO）可以提供完整的呼吸支持，而体外二氧化碳的去除有助于保护肺部通气，并且仅提供部分呼吸支持。采用传统的中央/外周方式或临时心室辅助装置配置的静脉动静脉（VA）机械循环支持可稳定失代偿性心力衰竭的患者，这些患者有端器官功能障碍的证据，从而有时间进行恢复，决策，过渡到长期机械循环支持设备的植入以及偶尔的心脏移植。在高度选择的合并严重心脏和呼吸衰竭的患者中，可以为晚期ECLS提供中央VA ECMO，周围VA ECMO，并在心肌恢复后及时过渡到静脉ECMO或VA-静脉ECMO，以避免上半身缺氧或通过添加充氧器到临时心室辅助设备电路。本文总结了可用的ECLS选项，并提供了对这些技术的原理和实践的见解。应该强调的是，与许多新兴疗法一样，目前最佳的使用尚无质量证据支持。需要解决这一缺陷，以确保可以充分发挥ECLS的潜力。

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