PDF(Pubmed)
Abstract：
Refractory septic shock is associated with a high risk of death. Circulatory support in the form of veno-arterial extracorporeal membrane oxygenation (VA ECMO) may function as a bridge to recovery, allowing for the treatment of the source of the sepsis. Whilst VA ECMO has been accepted as the means of hemodynamic support for children, in adults, single center observational studies show survival rates of only 70-90% for hypodynamic septic shock. The use of VA ECMO for circulatory support in hyperdynamic septic shock with preserved cardiac output or when applied late during cardio-pulmonary resuscitation is not recommended. With unresolving septic shock and a loss of ventriculo-arterial coupling, stress cardiomyopathy often develops. If the cardiac index (CI) approaches subnormal levels (CI < 2.5 L/min m-2) that do not match low systemic vascular resistance with a resulting loss of vital systemic perfusion pressure, VA ECMO support should be considered. A further decrease to the level of cardiogenic shock (CI < 1.8 L/min m-2) should be regarded as an indication for VA ECMO insertion. For patients who maintain a normal-to-high CI as part of their refractory vasoparalysis, VA ECMO support is justified in children and possibly in patients with a low body mass index. Extracorporeal support for septic shock should be limited to high-volume ECMO centers.
摘要：
难治性脓毒性休克与高死亡风险相关。静脉-动脉体外膜氧合（VAECMO）形式的循环支持可能是恢复的桥梁，允许治疗脓毒症的来源。虽然VAECMO已被接受为儿童的血液动力学支持手段，在成年人中,单中心观察性研究显示,低动力感染性休克的生存率仅为70-90%.不建议在保留心输出量的高动力感染性休克中或在心肺复苏期间后期使用VAECMO进行循环支持。无法解决的脓毒性休克和心室动脉耦合丧失，应激性心肌病经常发展。如果心脏指数（CI）接近低于正常水平（CI<2.5L/minm-2），与低全身血管阻力不匹配，导致重要的全身灌注压下降，应考虑VAECMO支持。心源性休克水平进一步降低（CI<1.8L/minm-2）应视为插入VAECMO的指征。对于维持正常至高CI作为难治性血管麻痹的一部分的患者，VAECMO支持在儿童以及体重指数较低的患者中是合理的。脓毒性休克的体外支持应仅限于高容量的ECMO中心。
