Objective To explore the value of extracorporeal membrane oxygenation(ECMO) combined with hypothermia therapy for children patients with refractory cardiac arrest after congenital heart disease surgery. Methods From January 2013 to June 2016, we conducted a prospective study of 23 children (18 males, 5 females at age of 7±11 months) who underwent ECMO for refractory cardiac arrest after congenital heart disease surgery. All patients were randomly divided into two groups: a standard group (11 patients) and a hypothermia group (12 patients). The patients of the standard group received standard therapy (the core body temperature maintaining at 37.0℃) and the hypothermia group received hypothermia therapy (the core body temperature maintaining at 33.0℃). The hospital discharge rate, the rate of weaning from ECMO and the morbidity were compared between the two groups. Results Eleven of 23 patients (47.8%) were weaned from ECMO successfully and 7 of 23 patients (30.4%) discharged from hospital. The hospital discharge rate between the hypothermia group (n=6, 50.0%) and the standard group (n=1, 9.1%) had no statistical difference (χ2=4.537, P=0.069). The rate of weaning from ECMO of the hypothermia group (n=9, 75.0%) was higher than that of the standard group (n=2, 18.2%, χ2=7.425, P=0.006). The morbidity between the two groups had no statistical difference. Conclusion Extracorporeal cardiopulmonary resuscitation can improve the survival rate of the children who suffered from refractory cardiac arrest after congenital heart disease surgery. There is no evidence that ECMO combined with hyperthermia therapy is better than the only ECMO in improving the discharge rate. But ECMO combined with hypothermia therapy has higher rate of weaning from ECMO than that of the only ECMO.
ObjectiveTo analyze the risk factors for pediatric heart transplantation at a single center and its impact on short-term prognosis, providing experience and reference for pediatric heart transplantation. MethodsThe children who underwent heart transplantation from May 2022 to May 2024 at the Seventh Medical Center of Chinese PLA General Hospital were included in this study. We conducted a retrospective analysis of the clinical data of donors and recipients, perioperative conditions, and postoperative complications. The double-lumen venoplasty technique was used for all surgeries. Basiliximab was applied for immune induction during and after the operation (on the 4th day). Tacrolimus+mycophenolate mofetil+prednisolone acetate was used for postoperative immunosuppressive maintenance treatment. According to whether patients had a history of extracorporeal membrane oxygenation (ECMO) installation before surgery, they were divided into an ECMO group and a non-ECMO group. The postoperative ICU stay time, postoperative ventilator assistance time, aortic clamping time, cardiopulmonary bypass time, recipient body surface area, left ventricular ejection fraction, X-ray cardiothoracic ratio, donor heart cold ischemia time, and the weight ratio between donor and recipient were compared between the two groups, and correlation analysis was performed. ResultsA total of 17 children were included, with 10 (58.8%) males and 7 (41.2%) females. Their ages ranged from 7 months to 16 years, with a median age of 11.0 (10.0, 13.0) years. Their weights ranged from 7.0 to 67.5 kg, with an average weight of (41.6±16.7) kg. Of the 17 children, 16 survived post-operation, and 1 died 5 days after the operation. Five patients were ABO incompatible heart transplantations, and 11 patients had a history of ECMO installation before surgery. The left ventricular ejection fraction of the non-ECMO group was higher than that of the ECMO group (t=2.188, P=0.045). The postoperative ICU stay time and postoperative ventilator assistance time (r=0.599, P=0.011), and cardiopulmonary bypass time (r=0.667, P=0.003) were positively correlated. The cardiothoracic ratio was negatively correlated with the postoperative ventilator assistance time (r=?0.527, P=0.030). ConclusionPediatric heart transplantation is an effective treatment method for children with end-stage heart failure. The left ventricular ejection fraction of the recipient may be a predictive factor indicating that the child needs ECMO assistance. Longer extracorporeal circulation time and larger recipient body surface area may affect the surgical process and perioperative prognosis.
ObjectiveTo analyze the early outcomes of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) patients with severe left ventricular dysfunction after surgical repair, and to explore the predictors for extracorporeal membrane oxygenation (ECMO) support for these patients.MethodsThe clinical data of ALCAPA patients with severe left ventricular dysfunction (left ventricular ejection fraction<40%) who underwent coronary artery reimplantation in the pediatric center of our hospital from 2013 to 2020 were retrospectively analyzed. The patients were divided into an ECMO group and a non-ECMO group. Clinical data of the two groups were compared and analyzed.ResultsA total of 64 ALCAPA patients were included. There were 7 patients in the ECMO group, including 4 males and 3 females aged 6.58±1.84 months. There were 57 pateints in the non-ECMO group, including 30 males and 27 females aged 4.34±2.56 months. The mortality of the patients was 6.25% (4/64), including 2 patients in the ECMO group, and 2 in the non-ECMO group. The postoperative complications rate was significantly higher in the ECMO group than that in the non-ECMO group (P=0.041). There were statistical differences in the cardiopulmonary bypass time [254 (153, 417) min vs. 106 (51, 192) min, P=0.013], aortic cross-clamping (ACC) time (89.57±13.66 min vs. 61.58±19.57 min, P=0.039), and preoperative left ventricular end-diastolic diameter/body surface area (132.32±14.71 mm/m2 vs. 108.00±29.64 mm/m2, P=0.040) between the two groups. Multivariate logistic regression analysis showed that ACC time was an independent risk factor for postoperative ECMO support (P=0.005). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve was 0.757, the sensitivity was 85.70%, specificity was 66.70%, with the cut-off value of 66 min.ConclusionACC time is an independent risk factor for postoperative ECMO support. Patients with an ACC time>66 min have a significantly higher risk for ECMO support after the surgery.
ObjectiveTo explore the diagnosis and treatment of severe adenovirus pneumonia patients with severe acute respiratory distress syndrome (ARDS) in a short time and reduce the complications after rehabilitation. MethodsThe clinical data, laboratory results, treatment process and imaging outcomes of three severe community-acquired adenovirus pneumonia patients with normal immune function were analyzed. ResultsAll the three patients developed ARDS in a very short time. In the early stage, alveolar lavage fluid obtained by fiberoptic bronchoscopy was taken for macrogenomic second-generation sequencing (mNGS), adenovirus was detected and antiviral drugs were immediately used. The first two patients received cidofovir antiviral therapy and the third patient received ribavirin antiviral therapy. All three patients received very high respiratory support, of which the first two received extracorporeal membrane oxygenation treatment. The lungs of all three patients recovered well after treatment. ConclusionsThe diagnosis and treatment of severe adenovirus pneumonia is still based on individualized symptomatic support, immune regulation and treatment of complications. mNGS can help diagnose and direct treatment of adenovirus pneumonia as early as possible, which is beneficial to reduce complications and improve survival rate.
Objective To investigate the indications, procedures, risks and efficacy of extracorporeal membrane oxygenation (ECMO) in bronchoscopic interventional surgery for patients with severe airway stenosis. Methods Retrospective analysis was performed on 6 patients with severe airway stenosis treated by bronchoscopic surgery under ECMO in West China Hospital from January 2018 to July 2021, and the experience of application was summarized in combination with 23 relevant literatures retrieved. Results Six patients on ECMO successfully completed bronchoscopic interventional surgery with satisfactory intraoperative oxygenation and no obvious hemostasis difficulties were observed. ECMO placement was as an emergency medical countermeasure in 3 patients while the other 3 patients were as preventive purpose. Following treatment, the shortness of breath index and mMRC score decreased and the patients were cured and discharged. During hospitalization, 3 patients had lower extremity deep vein thrombosis, and 1 patient with lower extremity swelling and pain, which was relieved after treatment with low molecular weight heparin. During discharge follow-up, 1 patient died due to airway stenosis, pulmonary infection, and subarachnoid hemorrhage secondary to cardiopulmonary resuscitation, while the other 5 patients did not show any worsening of dyspnea. Combined with the retrieval of 46 similar cases reported in the literature before 2020, it was concluded that these patients who met the application indications of ECMO and followed the shutdown procedure had a good prognosis and controllable risk. Conclusions ECMO can ensure the safety of patients with severe airway stenosis who need undergoing bronchoscopic interventional surgery for patients, improve the success rate of the operation and do not significantly increase the risk of bleeding. However, ECMO is difficult to operate and requires professional team management. Therefore, it is essential to master the indications of application, implement strict withdrawal procedures and necessary monitoring to improve the patient's cure rate and reduce the occurrence of adverse events.
[Abstract]The number of lung transplantation is gradually increasing worldwide, which brings new challenges to the multi-disciplinary team of lung transplantation. The prognosis of lung transplant recipients is seriously affected by the pathophysiological state of specific lung diseases and perioperative risk factors. It is of great significance for these patients to optimize perioperative management according to these factors. Recently, several expert consensus have been published regarding anesthesia management of lung transplantation. Based on the current evidence and clinical practice of West China Hospital, this review summarizes the key points of anesthesia management for lung transplant recipients to guide anesthesiologists' clinical practice.
Extracorporeal cardiopulmonary resuscitation (ECPR) is a salvage therapy for patients suffering cardiac arrest refractory to conventional resuscitation, and provides circulatory support in patients who fail to achieve a sustained return of spontaneous circulation. ECPR serves as a bridge therapy that maintains organ perfusion whilst the underlying etiology of the cardiac arrest is determined and treated. Increasing recognition of the survival benefit associated with ECPR has led to increased use of ECPR during the past decade. Commonly used indications for ECPR are: age<70 years, initial rhythm of ventricular fibrillation or ventricular tachycardia, witnessed arrest, bystander cardiopulmonary resuscitation within 5 min, failure to achieve sustained return of spontaneous circulation within 15 min of beginning cardiopulmonary resuscitation. This review provides an overview of ECPR utilization, recent outcomes, risk factors, and complications of ECPR. Identifying ECPR indications, rapid deployment of extracorporeal life support equipment, and high-quality ECPR management strategies are of paramount importance to improve survival.
On September 18th, 2023, the American Heart Association published clinical management guidelines for cardiac arrest and critical cardiac conditions caused by poisoning in the journal Circulation. Based on the differences in drug toxicity effects, our team has systematically interpreted the guidelines in three parts. This article, as the third part, focuses on interpreting the clinical management strategies for cardiac arrest caused by cyanide, organophosphates, carbamate and methemoglobinemia, and reviews the application of veno-arterial extracorporeal membrane oxygenation in poisoning treatment. Through in-depth analysis of the key recommendations in the guidelines, it aims to provide reference for clinical diagnosis and treatment.
As an extracorporeal life support technology, veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been demonstrated its role in the treatment of patients with severe respiratory failure. Its main advantages include the ability to maintain adequate oxygenation and remove excess CO2, increase oxygen delivery, improve tissue perfusion and metabolism, and implement lung protection strategies. Clinicians should accurately assess and identify the patient's condition, timely and accurately carry out VV-ECMO operation and management. This article will review the patient selection, cannulation strategy, anticoagulation, clinical management and weaning involved in the application of VV-ECMO.
ObjectiveTo explore the construction of heart preservation model of empty beating donor based on extracorporeal membrane oxygenation (ECMO). MethodsFrom January 2022 to August 2023, 20 Guangxi Bama miniature pigs weighing 25-30 kg were selected, half male and half female. Under general anesthesia and heparinization, a midline thoracotomy was performed. The pericardium was cut after freeing the anterior and posterior vena cavae, and a perfusion needle was inserted near the brachiocephalic artery in the ascending aorta, connected to a blood collection bag to collect 500-600 mL of blood. The anterior and posterior vena cavae were ligated, the aorta was blocked and perfused with HTK solution to stop the heart beating. The superior and inferior vena cavae were cut off, the right pulmonary vein was decompressed, the aorta and left and right pulmonary arteries and veins were cut off, and the whole heart was removed. An ECMO device was used to continuously perfuse a cardioprotective solution mainly composed of oxygenated warm blood, maintaining the isolated pig heart beating for 8 hours, monitoring (once/hour) ECMO perfusion parameters, blood gas indicators, perfusate electrolytes, detecting inflammatory factors, myocardial enzymes, myoglobin, and troponin levels. Myocardial tissue was taken for hematoxylin-eosin (HE) staining to observe myocardial cell damage and evaluate the quality of heart preservation. ResultsAmong the 20 isolated beating preservation pig hearts, 17 successfully resumed beating, 3 experienced ventricular fibrillation, resuscitated after intracardiac electrical defibrillation, and all 20 pig hearts successfully beat for 8 hours. There was no statistical difference in ECMO perfusion parameters, blood gas indicators, perfusate electrolytes, and inflammatory factors at each time point (P>0.05). There were statistical increases in myocardial enzymes, myoglobin, and troponin levels (P<0.05). HE staining results suggested that there was no severe myocardial damage. ConclusionECMO technology can be used for pig heart preservation with good results, and this study provides experimental evidence for improving heart preservation research in clinical heart transplantation.