(精选)【体外膜肺ECMO精品课件】 Veno-arterial ECLS for cardiogenic shock教学课件.pptVIP

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2018-03-21 发布于天津
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(精选)【体外膜肺ECMO精品课件】 Veno-arterial ECLS for cardiogenic shock教学课件.ppt

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Charles Hoopes MD University of Kentucky;Questions learning objectives…ECLS cardiogenic shock; “Our interventionists had a case recently where patient had a LAD PCI then was brought back a couple of days later for a RCA mid lesion. ?She arrested on insertion of the catheter in the aortic root -- never did a manipulation -- and after initial unsuccessful resuscitation, placed an impella and kept it up. ?They injected her L and it was open and, while still arrested opened the mid RCA. ?They called us after about 45 min of arrest when she was still in asystole. ?We then had ECMO there but ?by then it was an hour of arrest with no rhythm and felt ECMO would be futile. ?Do you have or know of any experience that would justify a trial of ECMO in this situation. ?I could understand if it was a bridge to recovery with severe shock, but with a rhythm -- or if there was a L main or other proximal lesion to open.”;41 yo male Vfib arrest (in house) … total occlusion LAD. Acute thrombosis of RCA during LAD PCI … ventricular arrhythmias with cardioversions x 16. IABP and Impella 2.5 … transferred to ICU with patent LAD, recurrent thrombosis of RCA (100% mid), inotropes. Clotting diathesis … ? 24 hours post cath … CI 1.6, Cr 5.5, AST 5000, lactate 6 …Q’s in II, III, aVF … trops 50. Adequate gas exchange … Return to cath lab … patent LAD, 100% mid RCA … Vfib ;“Defibrillation was attempted again but remained unsuccessful. CPR continued. We suspected that the patient’s heart was too distended to permit termination of ventricular fibrillation … a decision was made to consult cardiac surgery about the initiation of extracorporeal membrane oxygenation (ECMO) for full hemodynamic support and to decompress the heart and facilitate termination of ventricular fibrillation.”;Pubmed search: “ECMO and cardiogenic shock” … 403 citations (60% w/in the past 60 months);Trends in hospital case fatality rates in patients with acute myocardial infarct according to the presence of cardi