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Emergency use of extracorporeal membrane oxygenation in cardiopulmonary failure.

机译：紧急使用体外膜氧合治疗心肺功能衰竭。

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摘要

Severe pulmonary and cardiopulmonary failure resistant to critical care treatment leads to hypoxemia and hypoxia-dependent organ failure. New treatment options for cardiopulmonary failure are necessary even for patients in outlying medical facilities. If these patients are in need of specialized center treatment, additional emergency medical service has to be carried out quick and safely. We describe our experiences with a pumpless extracorporeal lung assist (PECLA/iLA) for out-of-center emergency treatment of hypercapnic respiratory failure and the use of a newly developed hand-held extracorporeal membrane oxygenation (ECMO) system in cardiac, pulmonary, and cardiopulmonary failure (EMERGENCY-LIFE Support System, ELS System, MAQUET Cardiopulmonary AG, Hechingen, Germany). Between March 2000 and April 2009, we used the PECLA System (n = 20) and the ELS System (n = 33) in adult patients. Cannulation was employed using percutaneous vessel access. The new hand-held ELS System consists of a centrifugal pump and a membrane oxygenator, both mounted on a special holder system for storing on a standard patient gurney for air or ground ambulance transfer. Bedside cannulation processes were uneventful. The PECLA System resulted in sufficient CO(2) removal. In all ECMO patients, oxygen delivery and systemic blood flow could be restored and vasopressor support was markedly down. Hospital survival rate in the PECLA group was 50%, and 61% in the ECMO group. Out-of-center emergency treatment of hypercapnic pulmonary failure with pumpless extracorporeal gas exchange and treatment of cardiac, pulmonary, and cardiopulmonary failure with this new hand-held ECMO device is safe and highlyeffective. Patient outcome in cardiopulmonary organ failure could be improved.
机译：对重症监护治疗有抵抗力的严重肺和心肺功能衰竭会导致低氧血症和缺氧依赖性器官衰竭。即使对于外围医疗机构中的患者，也必须有新的心肺衰竭治疗方案。如果这些患者需要专门的中心治疗，则必须快速安全地进行其他紧急医疗服务。我们描述了无泵体外肺部辅助治疗（PECLA / iLA）用于高碳酸血症性呼吸衰竭的偏心紧急治疗以及在心脏，肺部和心脏中使用新开发的手持式体外膜氧合（ECMO）系统的经验。心肺功能衰竭（急诊-生命支持系统，ELS系统，德国马辛根MAQUET心肺公司）。在2000年3月至2009年4月之间，我们在成年患者中使用了PECLA系统（n = 20）和ELS系统（n = 33）。通过经皮血管通路进行插管。新的手持式ELS系统由离心泵和膜式充氧器组成，二者均安装在特殊的支架系统上，用于存储在标准患者的轮床上以进行空中或地面救护车转移。床头插管过程很顺利。 PECLA系统导致足够的CO（2）去除。在所有ECMO患者中，可以恢复氧气输送和全身血流量，并且血管加压药支持明显下降。 PECLA组的医院生存率为50％，ECMO组为61％。使用这种新型手持式ECMO设备进行无泵体外气体交换的高碳酸血症性肺衰竭的偏心紧急治疗以及用心，肺和心肺功能衰竭进行治疗是安全且高效的。心肺器官衰竭的患者预后可以得到改善。

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