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中华重症医学电子杂志 ›› 2025, Vol. 11 ›› Issue (01) : 60 -64. doi: 10.3877/cma.j.issn.2096-1537.2025.01.013

指南解读

《成人体外膜肺氧合技术操作规范(2024年版)》解读:ECMO的撤离
张洁1, 席寅1, 王亚1, 徐永昊1, 黎毅敏1,()   
  1. 1. 510120 广州,广州医科大学附属第一医院重症医学科 广州呼吸健康研究院 国家呼吸医学中心 呼吸疾病全国重点实验室
  • 收稿日期:2025-01-15 出版日期:2025-02-28
  • 通信作者: 黎毅敏
  • 基金资助:
    国家自然科学基金项目(82241003)广东省医学科研基金项目(A2023440)

Interpretation of the Practice Standards for Adult Extracorporeal Membrane Oxygenation Technology(2024 Edition):weaning from ECMO

Jie Zhang1, Yin Xi1, Ya Wang1, Yonghao Xu1, Yimin Li1,()   

  1. 1. Department of Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou Institute of Respiratory and Health,National Center for Respiratory Medicine,State Key Laboratory of Respiratory Disease,Guangzhou 510120,China
  • Received:2025-01-15 Published:2025-02-28
  • Corresponding author: Yimin Li
引用本文:

张洁, 席寅, 王亚, 徐永昊, 黎毅敏. 《成人体外膜肺氧合技术操作规范(2024年版)》解读:ECMO的撤离[J/OL]. 中华重症医学电子杂志, 2025, 11(01): 60-64.

Jie Zhang, Yin Xi, Ya Wang, Yonghao Xu, Yimin Li. Interpretation of the Practice Standards for Adult Extracorporeal Membrane Oxygenation Technology(2024 Edition):weaning from ECMO[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2025, 11(01): 60-64.

国家卫生健康委于2024年首次发布了《成人体外膜肺氧合技术操作规范(2024年版)》,内容涵盖体外膜肺氧合(ECMO)技术的适应证/禁忌证、相关操作、管理等内容,旨在规范该技术的临床应用。本文主要对该规范中ECMO撤离部分的内容进行解读,促进对内容的理解以及提高其临床操作的可行性及依从性。

National Health Commission (NHC) first issued the Practice Standards for Adult Extracorporeal Membrane Oxygenation Technology (2024 Edition),which covers the indications/contraindications,related operations and management of ECMO technology,aiming to standardize its application. We mainly interpret the part of weaning from ECMO in this specification,aiming to enhance understanding and improve the feasibility and compliance of its clinical application.

1
国家卫生健康委办公厅. 成人体外膜肺氧合技术操作规范 (2024年版)[EB/OL]. (2024-11-26) [2024-12-09]. http://www.nhc.gov.cn/yzygj/s3585/202411/fc18e0056d8b4a4f8710f90e7db902d3.shtml.
2
Tonna JE,Abrams D,Brodie D,et al. Management of adult patients supported with venovenous extracorporeal membrane oxygenation(VV-ECMO):guideline from the Extracorporeal Life Support Organization (ELSO) [J]. ASAIO J,2021,67(6):601-610.
3
Slutsky AS,Ranieri VM. Ventilator-induced lung injury [J]. N Engl J Med,2013,369(22):2126-2136.
4
Brochard L,Slutsky A,Pesenti A. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure [J]. Am J Respir Crit Care Med,2017,195(4):438-442.
5
Vasques F,Romitti F,Gattinoni L,et al. How I wean patients from veno-venous extra-corporeal membrane oxygenation [J]. Crit Care,2019,23(1):316.
6
Al-Fares AA,Ferguson ND,Ma J,et al. Achieving safe liberation during weaning from VV-ECMO in patients with severe ARDS:the role of tidal volume and inspiratory effort [J]. Chest,2021,160(5):1704-1713.
7
Lazzari S,Romitti F,Busana M,et al. End-tidal to arterial PCO2 ratio as guide to weaning from venovenous extracorporeal membrane oxygenation [J]. Am J Respir Crit Care Med,2022,206(8):973-980.
8
Goligher EC,Jonkman AH,Dianti J,et al. Clinical strategies for implementing lung and diaphragm-protective ventilation:avoiding insufficient and excessive effort [J]. Intensive Care Med,2020,46(12):2314-2326.
9
Parzy G,Daviet F,Persico N,et al. Prevalence and risk factors for thrombotic complications following venovenous extracorporeal membrane oxygenation:a CT scan study [J]. Crit Care Med,2020,48(2):192-199.
10
Fisser C,Reichenbächer C,Müller T,et al. Incidence and risk factors for cannula-related venous thrombosis after venovenous extracorporeal membrane oxygenation in adult patients with acute respiratory failure[J]. Crit Care Med,2019,47(4):e332-e339.
11
Meuwese CL,Brodie D,Donker DW. The ABCDE approach to difficult weaning from venoarterial extracorporeal membrane oxygenation [J]. Crit Care,2022,26(1):216.
12
Saeed D,Potapov E,Loforte A,et al; Durable MCS after ECLS Study Group. Transition from temporary to durable circulatory support systems [J]. J Am Coll Cardiol,2020,76(25):2956-2964.
13
Ostadal P,Mlcek M,Kruger A,et al. Increasing venoarterial extracorporeal membrane oxygenation flow negatively affects left ventricular performance in a porcine model of cardiogenic shock [J]. J Transl Med,2015,13:266.
14
Lorusso R,Shekar K,MacLaren G,et al. ELSO interim guidelines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients [J]. ASAIO J,2021,67(8):827-844.
15
Aissaoui N,Luyt CE,Leprince P,et al. Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock [J]. Intensive Care Med,2011,37(11):1738-1745.
16
Westrope C,Harvey C,Robinson S,et al. Pump controlled retrograde trial off from VA-ECMO [J]. ASAIO J,2013,59(5):517-519.
17
Babar ZU,Sharma AS,Ganushchak YM,et al. An arterio-venous bridge for gradual weaning from adult veno-arterial extracorporeal life support [J]. Perfusion,2015,30(8):683-688.
18
Danial P,Hajage D,Nguyen LS,et al. Percutaneous versus surgical femoro-femoral veno-arterial ECMO:a propensity score matched study [J]. Intensive Care Med,2018,44(12):2153-2161.
19
Majunke N,Mangner N,Linke A,et al. Comparison of percutaneous closure versus surgical femoral cutdown for decannulation of largesized arterial and venous access sites in adults after successful weaning of veno-arterial extracorporeal membrane oxygenation [J]. J Invasive Cardiol,2016,28(10):415-419.
20
Peng K,Hu L,Huang Ⅹ,et al. Innovative percutaneous 3-stitch suture technique for site closure in venoarterial extracorporeal membrane oxygenation decannulation without direct artery repair:a case series [J].ASAIO J,2024,70(9):787-794.
21
Thangappan K,Cavarocchi NC,Baram M,et al. Systemic inflammatory response syndrome (SIRS) after extracorporeal membrane oxygenation (ECMO):incidence,risks and survivals [J].Heart Lung,2016,45(5):449-453.
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