Title: Extracorporeal Membrane Oxygenation (ECMO)
题目：2012年的体外膜肺氧合 （ECMO）
Authors 作者: Haney Mallemat and John Greenwood

I. Venovenous ECMO (VV ECMO) 静脉静脉－体外膜肺氧合（VV－ECMO）
a. Started off being used in pediatric patients in the 1970’s
最开始是在1970年代用于儿科患者
b. Now being used more for adults with reversible lung processes or as a bridge to lung transplant
现在多用于患有可逆性肺疾病或需要肺移植的患者
c. Only used as an oxygenator to give the lungs a break while it heals from its reversible process or while awaiting lung transplant
只是作为一个给肺可逆性病变恢复时间或等待肺移植时的氧合器
d. A criteria for its use is that the patient must have a good intrinsic
mechanical pump or heart
应用它的前提是患者一定要有一个好的内在机械泵（心脏）

II. Venoarterial ECMO (VA ECMO) 静脉动脉－体外膜肺氧合（VA－ECMO）
a. Recently been used a lot more frequently and now something that is available for ED physicians
最近应用相当多，也是现在急诊医生就可以用的治疗手段
b. Works similarly to VV ECMO except that it also provides circulatory support
与VV-ECMO相式，但它同时还支持循环系统
c. Should be thought of as a way to give the heart and lungs a break from this reversible disease process
作为争取给心和肺从可逆性病变恢复时间的一个方式
d. Primary use is in refractory cardiogenic shock and should be considered early to get the most benefit
主要用于顽固性心源性休克，为得到最好的效果，要尽早用
e. Complications 合并症
i. Limb ischemia 肢体缺血
ii. Artery laceration 动脉撕裂
iii. Patients need to be anticoagulated 患者需要抗凝

End goal is to buy more time to PCI, CABG, or heart transplant
最终的目的是为经皮冠状动脉介入，冠状动脉搭桥，或心移植争取时间
Patients usually are on vasopressors but will not need them once on ECMO
一旦用上ECMO，患者就不需要通常在用的升压药
Could possibly be used in the community setting as a bridge to transport
也可以为郊区医院转运患者中应用

III. Use in cardiac arrest 在心脏骤停患者中的应用
A few small case studies show it is associated with good outcomes
只有几个小样本的病例总结报告了它与良性预后有关
A very select population to consider its use
仅有的几个应用适应症
i. Relatively healthy 相对健康
ii. Short down times (<10 minutes) 骤停时间段（少于10分钟）
iii. Should have a reversible cause to their cardiac arrest
造成心脏骤停的原因是可逆的
No risks for adverse outcomes from ECMO use
ECMO的使用不会造成恶性后果

References 参考文献

1. Peura JL, Colvin-Adams M, et al. Recommendations for the use of mechanical circulatory support: device strategies and patient selection. Circulation. 2012; 126: 2648-2667.
2. Sayer GT, Baker JN, Parks KA. Heart rescue: the role of mechanical circulatory support in the management of severe refractory cardiogenic shock. Curr Opin Crit Care 2012;18:409-416.