​Title: VV-ECMO for Refractory Hypoxemia
题目：静脉静脉－体外膜肺氧合治疗顽固性缺氧
Author 作者: Michael Winters

• In the absence of significant cardiac disease, patients with refractory hypoxic respiratory failure should be considered for venovenous extracorporeal membrane oxygenation (VV-ECMO).

• 在没有明显心脏疾病情况下，对顽固性缺氧性呼吸衰竭的病人，可考虑使用静脉静脉－体外膜肺氧合（VV-ECMO）。

• Though indications vary slightly among organizations, the Extracorporeal Life Support Organization states that ECMO is indicated when the PaO2/FiO2 is < 80 mm Hg on FiO2 > 90% or safe plateau pressures (< 30 cm H2O) cannot be maintained.

• 虽然每个医疗机构的应用指征会有所差异，体外生命支持协会明确指出应用ECMO的指征包括吸入氧浓度（FiO2）超过90％时，PaO2／FiO2 小于80 mmHg；或不能够维持安全的平台压力（低于30 cmH2O）。

• A few pearls when initiating VV-ECMO:

• 在使用VV-ECMO时一定要注意：

◦ Fluids are often needed in the first few hours after initiation of ECMO

◦ 在前几个小时内，经常需要液体。

◦ Reduce tidal volumes to maintain plateau pressures < 25 cm H2O

◦ 减低潮气量，维持平台压低于25 cmH2O。

◦ Decrease FiO2 to maintain oxygen saturations > 88%

◦ 降低FiO2，维持氧饱和度大于88％即可。

◦ Use a hemoglobin threshold of 7-8 g/dL for blood transfusion

◦ 血红蛋白低于7－8g／dl时才考虑输血。

References 参考文献

Combes A, et al. What is the niche for extracorporeal membrane oxygenation in severe acute respiratory distress syndrome? Curr Opin Crit Care 2012; 18:527-532.