Abstract:Objective To explore the clinical efficacy of extracorporeal membrane oxygenation (ECMO) in the treatment of refractory cardiogenic shock and to analyze factors affecting the clinical efficacy.Methods We retrospectively analyzed the clinical data of 9 patients with refractory cardiogenic shock treated by ECMO from January 2016 to June 2016,ECMO pre-status,ECMO timing,ECMO complications and curative effects,The dose of vasoactive drugs and hemodynamic changes were collected before and during 2 h,6 h,12 h,24 h and 48 h of ECMO use.Results 5 males and 4 females were selected in our study,aged from 12 to 56 years old,with acute myocardial infarction in 3 cases,acute fulminant myocarditis in 4 cases,paroxysmal ventricular tachycardia in 1 case,coronary artery bypass grafting in 1 case.6 patients underwent CPR with CPR time ranged from10 to 180 mins.2 patients underwent PCI.1 patient with acute extensive anterior myocardial infarction experienced a three-degree atrioventricular block after resuscitation and implanted pacemaker;1 case of temporary pacemaker with ventricular tachycardia;2 patients with IABP support.The mean arterial pressure increased at 2 h after application of ECMO,the central venous pressure decreased,the central venous oxygen saturation increased,the amount of vasoactive drugs decreased gradually,and the differences were statistically significant (P<0.05).After 12 hours of ECMO support,the lactic acid level began to decline with pH value improved,and the differences were statistically significant (P<0.05).Shock was improved with stable hemodynamics after 24 hours of ECMO.ECMO auxiliary time ranged from 12 to 220 h.8 of 9 cases were successfully weaned(88.9％),with 5 of whom survived to discharge(55.6％).4 patients died due to acute renal insufficiency,disseminated intravascular coagulation,delayed application of ECMO,a variety of complications,abandon of treatment by family and other causes.Conclusion ECMO can quickly improve cardiogenic shock in patients and maintain the stability of hemodynamics.Timely ECMO use,improvement of clinical care and reduction of body complications are the key to improve the efficacy of ECMO.

Abstract:Objective To summarize the prevention and management strategy of lower extremity ischemia and thrombotic complications during femoral arteriovenous extracorporeal membrane oxygenation (ECMO). Methods Clinical data of 22 patients with ECMO (V-A mode) assisted treatment for circulatory failure from May 2014 to March 2018 were analyzed retrospectively. The distal end of lower extremity perfusion and complications of those patients were also analyzed. Results Of the 22 patients, 13 cases were successfully weaned from ECMO (59.1％). During 2014 and 2016, a distal perfusion cannula was routinely placed through superficial femoral artery (17 cases); from 2017 to present, distal perfusion cannulation was not routinely placed, and the placement was decided according to the clinical situation and lower extremity ultrasound blood flow (Of five cases, three were not cannulated whereas two were cannulated thereafter). Among them, three patients suffered from lower extremity swelling. There were two cases of macula, which improved after the distal perfusion tube was placed under the guidance of ultrasound, and no lower limb ischemia or necrosis occurred.Conclusion ECMO plays an important role in the treatment of acute circulatory failure. Lower extremity complications have great impacts on the prognosis. According to the conditions of patients, rational placement of distal perfusion, anticoagulant and distal flow management are needed to reduce the rate of disability and to improve the success rate of ECMO and the life quality of patients.

Abstract:Objective Activated clotting time (ACT) has been the preferred monitoring index in extracorporeal membrane oxygenation (ECMO) patients for long. This retrospective study sought to evaluate the relationship between activated clotting time (ACT) and activated partial thromboplastin time (APTT) when they were used to monitor anticoagulation in patients undergoing extracorporeal membrane oxygenation (ECMO). Methods Patients administered with heparin during ECMO were included in this study. The primary endpoint was the relationship between paired ACT and APTT samples. Results Twenty-two patients who met the criteria for the study were included. Pearson analysis found weak correlation between ACT and APTT (r = 0.114, P = 0.003), and weak correlation between ACT and APTT was also founded in patients who benefited from venovenous ECMO (r = 0. 229, P = 0. 001). The levels of APTT (51.1±27.5 s) and ACT (196.1±35.7 s) in V-V ECMO group were different from those in V-A ECMO group (46.1±27.7 s for APTT and 205.4±33.1 s for ACT, respectively) with a statistical difference in ACT (P = 0.013). Compared with survivours, platelet count declined significantly (P ＜0.001) in nonsurvivors. Conclusion There was a weak correlation between ACT and APTT in patients supported with ECMO. The coagulation indices of different ECMO modes were different. Platelet count declined significantly during the treatment of ECMO in critical patients and was related to their prognosis.

Abstract:Objective To summarize and evaluate the clinical effect of extracorporeal membrane oxygenation support for criti-cally ill patients after heart surgery. Methods 8 patients with cardiopulmonary functional failure after heart surgery received ECMO support from March 2014 to May 2016 ,and 6 patients ( support time>8 hours) were retrospectively analyzed. Results Low cardiac output syndrome occurred in 5 patients, and acute respiratory failure happened in 1 patient, who failed to respond to routine medical therapy. All patients received V-A ECMO. The mean age was (51.8±10.4)years.The aver age support time was(109.8±27.1) hours. Three ( 50%) patients successfully weaned from ECMO and 1 ( 16,7%) was discharged from hospital. Complications:renal failure with continuous renal replacement therapy was seen in 4 cases,4 cases had hemorrhage( 2 cases of catheter hemorrhage and 2 cases of hemo-thorax) and 1 case of infection after ECMO. Conclusion ECMO is an life supporting approach for patients with reversible cardiopul-monary failure after heart surgery. The keys to optimal results include earlier use of ECMO, the application of lung protective ventilation strategy,prevention and control of bleeding.