ABSTRACT:Introduction : Elevated cell-free DNA (cfDNA) was observed in patients receiving venoarterial (VA) extracorporeal membrane oxygenation (ECMO), but the clinical relevance of cfDNA is still not clear. We aimed to establish a predictive model based on the cfDNA to predict the prognosis for patients on ECMO, and reveal the values of cfDNA for complications of limb ischemia and bleeding/thromboembolic events. Methods : Single-center, retrospective evaluation of patients with ECMO support from 2018 through 2023. The derivation cohort included 133 adults diagnosed with cardiogenic shock who received VA-ECMO for circulatory support. We developed three independent features and combined them with a logistic model to predict mortality. Predictive performance was assessed through Bootstrap analysis and validated by another cohort of 27 patients. The values of cfDNA for complications were analyzed by restricted cubic spline analysis, receiver-operating characteristic curves and multivariate regression analyses. Results : A total of 133 adults who underwent VA-ECMO for refractory cardiogenic shock were entered into the derivation cohort. The logistic model, consisted of cfDNA, the worst mean arterial pressure (MAP) before ECMO and the worst lactate within 24 h of VA-ECMO implantation was predictive and performed similarly for validation cohorts (area under the receiver operating characteristic curve: 0.768 vs. 0.747). Restricted cubic spline analysis revealed a positive linear relationship for the risk of limb ischemia (linear, P = 0.006; area under the receiver operating characteristic curve of 0.75 [95% CI, 0.656-0.848]), a U-shaped trend for bleeding events (nonlinear, P = 0.214), and a negative trend for thrombotic events (linear, P = 0.552). Conclusions: In addition to MAP and lactate levels, elevated cfDNA levels within 48 h of ECMO support were highly associated with mortality for patients. Additionally, cfDNA is predictive of limb ischemia.

Objective This study aimed to evaluate the relationship between plasma soluble ST2 (sST2) levels 24 h after extracorporeal membrane oxygenation (ECMO) initiation and continuous renal replacement therapy (CRRT) in patients receiving venoarterial ECMO (V-A ECMO) support. Methods and Results Data of patients who received ECMO support for postcardiotomy cardiogenic shock between January 2017 and July 2019 were retrospectively collected from Beijing Anzhen Hospital, Capital Medical University. Ultimately, 116 patients were included in the present study for analysis. The concentration of sST2 was determined by enzyme-linked immunosorbent assay (ELISA). The log 10 sST2 levels were higher in patients undergoing CRRT than those who did not (6.06 vs. 6.22, p = 0.019). Patients undergoing CRRT had a lower survival rate than those who did not (32.8% vs. 67.3%, p < 0.001). In the univariate logistic regression analysis, sST2, HCO 3 - , lactate, and creatinine levels 24 h after ECMO initiation were related to CRRT ( p < 0.05). In the multivariate logistic regression analysis, HCO 3 - and sST2 were identified as independent risk factors for CRRT use in patients undergoing ECMO ( p < 0.05). The area under receiver operator characteristic curve (AUC) for sST2 and HCO 3 - together was 0.72 (95% confidence interval (CI), 0.79–0.91), which was better than those of sST2 or HCO 3 - alone (0.63 vs. 0.67). Conclusions sST2 and HCO 3 − levels at 24 h after ECMO initiation were associated with CRRT and could predict CRRT use in postcardiotomy cardiogenic shock patients undergoing ECMO.

ObjectiveVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide temporary circulatory and respiratory support allowing hemodynamic stabilization during high-risk transcatheter aortic valve replacement (TAVR). However, the optimal timing of VA-ECMO use in high-risk TAVR remains controversial. We aimed to report our experience using a novel standby ECMO strategy during high-risk TAVR.MethodsWe retrospectively evaluated consecutive patients who received high-risk TAVR with standby ECMO between March 1,2023 and March 1,2024 at the Beijing Anzhen Hospital. Small, 5F or 6F sheaths were placed in ipsilateral femoral vein and artery before TAVR procedures. The primary outcome of this study was survival to hospital discharge with good neurological recovery defined as cerebral performance category (CPC) 1-2.ResultsA total of 24 patients undergoing high-risk TAVR with standby ECMO were included. Six (25.0%) of the 24 patients with standby ECMO suffered from cardiogenic shock or cardiac arrest and required emergency VA-ECMO institution. The median (IQR) cannulation time was 8 (6-11) minutes, and the median (IQR) ECMO duration was 35 (24-48) hours. All of the 24 patients underwent successful TAVR procedures and survival to hospital discharge with CPC1-2.ConclusionsStandby ECMO with preset femoral vascular sheaths was feasible and effective for refractory cardiogenic shock and cardiac arrest during high-risk TAVR.

目的 通过理论知识和综合评分评估体外膜氧合(ECMO)高仿真模拟培训在医学临床教育的效果,同时观察有无ECMO临床经验是否影响培训的效果.方法 选取2022年9月至2022年12月期间本中心进修学员作为参与者,4名具有教学资格的本中心医生作为模拟培训讲师,时间为期2天.通过专业笔试、考核指标及问卷调查等形式评估培训效果.结果 共有20名参与者纳入此研究,75％参与者为临床医师,有45％参与者的所属医院至今没有开展ECMO.研究结果发现所有参与者经过高仿真模拟培训后理论知识、综合评分等各项指标均得到明显的提高(P＜0.05),且无ECMO临床经验的参与者得到相同的效果.结论 ECMO高仿真模拟培训可明显改善参与者ECMO相关理论知识和处理问题的能力,且不受是否有ECMO临床经验的影响.

Objective Aiming to evaluate the clinical efficacy of extracorporeal membrane oxygenation（ECMO） in postpartum patients in China. Methods This study retrospectively analyzed postpartum ECMO cases reported to the Chinese Society of Extracorporeal Life Support（CSECLS） from February 1, 2017 to June 30, 2021. Demographics, indications, ECMO mode, complications, and outcomes of the patients were analyzed and evaluated. Results Thirteen postpartum patients from 8 hospitals were enrolled, and the median age was 28（27, 33） years. Seven patients（53.8%） received veno-venous ECMO（VV ECMO）, while six patients（46.2%） received veno-arterial ECMO（VA ECMO）. Twelve cases（92.3%） were cannulated by the precancerous method. The lactate before ECMO was 9.6（1.3, 12.2） mmol/L. The complications included 6（46.2%） cases of hemorrhage, 5（38.5%） cases of hyperbilirubinemia, 1（7.7%） case of seizure, and 1（7.7%） case of distal limb ischemia. The median ECMO duration was 154（78, 400） hours, the median mechanical ventilation duration was 297（111, 454） hours, the median ICU length of stay was 13（4, 36） days, and the median hospital length of stay was 25（4, 59） days. Eleven patients were successfully weaned from ECMO, and eight patients survived to discharge（61.5%）. Conclusion The application of ECMO in postpartum patients with acute respiratory failure or acute heart failure is feasible and effective. Hemorrhage is one of the most common complications for postpartum ECMO patients.

AbstractAimsTo investigate the impact of intra‐aortic balloon pump (IABP) on the regional haemodynamics of patients with severe cardiogenic shock undergoing femoro‐femoral veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO).Methods and resultsFrom July 2017 to April 2018, a total of 39 adult patients with cardiogenic shock receiving both IABP and ECMO for circulatory support were enrolled consecutively in a university‐affiliated cardiac surgery intensive care unit. The blood flow rates (BFRs) of the bilateral femoral artery (IABP side: iFA, ECMO side: eFA) and carotid artery (left: LCA, right: RCA) and the velocity time integral (VTI) of aortic root were assessed by ultrasonography and compared when IABP was on and off. Seventeen of 39 (43.6%) patients survived to discharge, and 29 (74.4%) survived on ECMO. A total of 172 pairs of data (IABP on and off) were collected in this study, measured on the median of 2.0 (1.0, 4.5) days after patients received VA‐ECMO. The BFR on both sides of FA (iFA: 176.4 ± 104.5 vs. 152.2 ± 139.8 mL/min, P < 0.01; eFA: 299.3 ± 279.9 vs. 242.4 ± 258.8 mL/min, P < 0.01) and the aortic VTI (10.1 ± 4.4 vs. 8.5 ± 4.4 cm, P < 0.01) decreased significantly when turning the IABP off, while the BFR on both sides of CA remained unchanged (LCA: 555.7 ± 326.9 vs. 578.6 ± 328.0 mL/min, P = 0.27; RCA: 550.0 ± 331.1 vs. 533.0 ± 303.5 mL/min, P = 0.30). The LCA BFR dramatically increased after turning the IABP off (296.8 ± 129.7 vs. 401.4 ± 278.1 mL/min, P = 0.02) in patients with cardiac stunning (defined as pulse pressure ≤ 5 mmHg). However, there was no significant difference in LCA BFR between IABP‐On and IABD‐Off (359.6 ± 105.4 mL/min vs. 389.6 ± 139.3 mL/min, P = 0.31) in patients with cardiac stunning receiving a higher ECMO blood flow (> 3.5 L/min).ConclusionsConcomitant IABP used in patients undergoing femoro‐femoral VA‐ECMO was associated with increased aortic VTI and BFR in bilateral FA. The change in CA BFR depended on cardiac function. A decreased LCA BFR was observed in patients with cardiac stunning when IABP was turned on, which might be compensated by a higher ECMO blood flow. Further study is needed to confirm the relationship between BFR and extremities and neurological complications.

Objective To investigate the feasibility of drainage from the superior vena cava (SVC) to improve upper body oxygenation in patients with cardiogenic shock undergoing femoral veno-arterial extracorporeal membrane oxygenation (VA ECMO). Methods Seventeen adult patients receiving peripheral femoral VA ECMO for circulatory support were enrolled. The femoral drainage cannula was shifted three times (from the inferior vena cava (IVC) level to the SVC level and then the IVC level again), all under ultrasound guidance, at an interval of 15 minutes. The blood gas levels of the right radial artery (RA) and SVC and cerebral oxygen saturation (ScO2) were measured and compared. Results Fifteen patients (88.2%) were successfully weaned from ECMO, and 12 patients (70.6%) survived to discharge. The oxygen saturation (SO2) and oxygen partial pressure (PO2) of the RA (97.0 ± 3.5% to 98.3 ± 1.5%, P < 0.05, SO2; 127.4 ± 58.2 mmHg to 153.1 ± 67.8 mmHg, P < 0.05, PO2) and SVC (69.5 ± 9.0% to 75.7 ± 8.5%, P < 0.05, SO2; 38.5 ± 5.6 mmHg to 43.6 ± 6.4 mmHg, P < 0.05, PO2) were increased; ScO2 was also increased on both sides (left: 50.6 ± 8.6% to 55.0 ± 9.0%, P < 0.05; right: 48.7 ± 9.2% to 52.3 ± 9.8%, P < 0.05) when the femoral drainage cannula was shifted from the IVC level to the SVC level. When the femoral drainage cannula was shifted from SVC level to the IVC level again, the SO2 and PO2 of RA (98.3 ± 1.5% to 96.9 ± 3.2%, P <0.05, SO2; 153.1 ± 67.8 mmHg to 125.8 ± 63.3 mmHg, P <0.05, PO2) and SVC (75.7 ± 38.5% to 70.4 ± 7.6%, P <0.05, SO2; 43.6 ± 6.4 mmHg to 38.9 ± 4.5 mmHg, P <0.05, PO2) were decreased; ScO2 was also reduced on both sides (left: 55.0 ± 9.0% to 50.7 ± 8.2%, P < 0.05; right: 52.3 ± 9.8% to 48.7 ± 9.3%, P <0.05). Conclusion Drainage from the SVC by shifting the cannula upward could improve upper body oxygenation in patients with cardiogenic shock undergoing femoral VA ECMO. This cannulation strategy provides an alternative solution for differential hypoxia.

近年来,体外膜氧合(extracorporeal membrane oxygenation,ECMO)广泛应用于各种危重症患者的辅助治疗,其辅助效果与从业人员的能力紧密相关.因此,ECMO从业人员的培训与继续教育对安全开展ECMO项目有着重要意义.由于ECMO的救治对象通常为极危重症患者,且其技术本身复杂、风险较高,还具有地域开展不均衡和需多学科团队协作等特点,故使得ECMO技术的培训与继续教育存在一定特殊性与局限性.目前国内仍然没有较为完整的ECMO培训体系.因此,为加强ECMO专业人才培养,规范化开展ECMO技术培训,近年来,中国体外生命支持组织(Chinese Extracorporeal Life Support Organization,ChECLS)开展了高仿真情景ECMO模拟培训项目,其主要内容包括ECMO的建立、ECMO辅助期间的管理和ECMO的撤机等.学员经过培训后,能够快速安全地进行ECMO的建立与撤除,对辅助期间的突发意外能够做出迅速、准确的判断并积极应对,取得了较好的培训效果.

目的 对接受静脉-动脉体外膜氧合(V-A ECMO)辅助的心脏术后心源性休克患者血管并发症的发生情况进行分析,评估血管并发症发生的危险因素以及对患者预后的影响.方法 本研究为单中心回顾性研究,纳入2017年1月至2020年12月接受股静脉-股动静V-A ECMO辅助的成人心脏术后心源性休克(PCS)患者,根据有无血管并发症将患者分为两组,比较临床预后,并采用多因素分析确定血管并发症的危险因素.结果 331例接受V-A ECMO治疗的PCS患者中,118例(35.6％)发生血管并发症,其中6例(1.8％)出现下肢缺血或插管处动脉血栓需手术干预,16例(4.8％)插管部位出血需要手术干预,其余96例(29.0％)出现轻度下肢缺血无须处理.年龄大于或等于60岁(OR 1.797,P=0.020)、ECMO前6 h血乳酸水平(OR 1.062,P=0.002)、ECMO前6 h序贯器官衰竭(SOFA)评分(OR 1.160,P=0.025)、单纯冠状动脉旁路移植术(CABG)(OR 0.576,P=0.032)与血管并发症相关.有和无血管并发症患者的住院生存率分别为22.9％和45.5％(P<0.001).结论 血管并发症与较高的住院死亡率相关.年龄大于或等于60岁、ECMO前6 h血乳酸水平及SOFA评分是发生血管并发症的独立危险因素,而单纯CABG术则为血管并发症发生的独立保护性因素.

Aorta angiography in IVC-FA. The catheter for contrast medium injection was placed into the descending aorta near the return cannula in the femoral artery. The blood from the return cannula could reach the diaphragm level, but could not supply the upper body. IVC-FA: drainage cannula is placed within the inferior vena cava through the femoral vein and return cannula is in the femoral artery.

Objective:To investigate the safety and the efficacy of percutaneous and surgical approach in femoro-femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation.Methods:All consecutive patients implanted with femoro-femoral VA-ECMO between January 2018 and December 2020 in Beijing Anzhen Hospital, Capital Medical University. Propensity score matching was used to compare outcomes of percutaneous and surgical groups while controlling for confounders.Results:Among the 276 patients who received femoro-femoral VA-ECMO (62 surgical and 214 percutaneous), propensity-score matching selected 52 pairs of patients with similar characteristics with mean age of(59.6±13.0)years old, in which 26 patients were female. There were a lower ECMO cannulation-associated complication (28.8% vs. 48.1%, P=0.044) and a lower hospital mortality (42.3% vs. 67.3%, P=0.010) in the percutaneous group. The circuit blood flow after ECMO initiation was similar in both groups[(3.3±0.8)L·min -1·kg -1 in percutaneous group vs. (3.2±0.7)L·min -1·kg -1 in surgical group, P=0.738]. The serum lactate was declined in both group after ECMO initiation[(5.4±5.8)mmol/L vs. (9.2±6.9)mmol/L, P<0.001 in percutaneous group; (6.3±6.2)mmol/L vs. (10.5±7.0)mmol/L, P=0.003 in surgical group]. Conclusion:Percutaneous approach is a safe and efficient technique in emoro-femoral VA-ECMO cannulation. Compared with surgical cannulation, percutaneous approach is associated with lower ECMO cannulation-associated complication and lower hospital mortality.

Long-term bone defects are a key clinical problem. Autogenous bone graft remains the gold standard for the treatment of these defects; however, improving the osteogenic properties and reducing the amount of autogenous bone is challenging. Autologous platelet-rich plasma (PRP) has been widely considered for treatment, due to its potentially beneficial effect on bone regeneration and vascularization. The aim of the present study was to explore the effects of autogenous bone particles combined with PRP on repairing segmental bone defects in rabbits. Briefly, a critical-size diaphyseal radius defect was established in 45 New Zealand White rabbits. Animals were randomly divided into four groups, according to the different implants: Group A, empty bone defect; group B, PRP; group C, autogenous bone particles + bone mesenchymal stem cells (BMSCs) on the left radius; group D, autogenous bone particles + PRP + BMSCs on the right radius. Bone samples were collected and further analyzed using X-ray, histology and histomorphometry 4, 8 and 12 weeks post-surgery. In addition, the effect of PRP on cell proliferation was detected by Cell Counting Kit-8 and the concentrations of growth factors (GFs), transforming GF (TGF)-β1 and platelet-derived GF (PDGF), in PRP were verified by ELISA. X-ray, histology and histomorphometry data revealed that the fraction area of the newly formed bone was larger in group D. In addition, PRP could improve cell proliferation, osteogenic differentiation and the release of GFs, TGF-β1 and PDGF-AB. In conclusion, these findings indicated that an autogenous bone particle + PRP + BMSC scaffold may be used as a potential treatment strategy for segmental defects in humans.

目的 分析体外膜氧合(ECMO)用于老年患者(年龄≥65岁)难治性心脏术后心源性休克(PCCS)的临床结果.方法 总结分析2004年5月至2017年12月间139例老年PCCS患者进行ECMO辅助临床资料,按照是否存活出院分为存活出院组(SG,n=34)和院内死亡组(DG,n=105),分析影响老年患者临床预后的相关风险因素.结果 71例(51.1％)患者成功撤机,34例(24.5％)患者存活出院.与SG组患者相比较,DG组患者启动ECMO时乳酸水平、血管活性药物指数和器官衰竭序贯评分较高,差异有统计学意义(P<0.01).DG组患者ECMO辅助期间严重神经系统并发症和肾脏功能衰竭需要持续性肾替代治疗(CRRT)发生率较高,差异有统计学意义(P<0.01).多元回归分析结果提示心脏功能衰竭、严重神经系统并发症和需要CRRT的肾脏功能衰竭是影响患者临床预后的独立高危风险因素.结论 ECMO能够为老年PCCS患者提供有效循环辅助,挽救部分患者生命.

Objectives: The benefit of preoperative intra-aortic balloon pump implantation in high-risk cardiac surgery patients is still debated. The role of preoperative intra-aortic balloon pump insertion in acute myocardial infarction patients without cardiogenic shock undergoing off-pump coronary artery bypass grafting remains unknown. This study aimed to determine the efficacy and safety of the preoperative intra-aortic balloon pump insertion in those patients undergoing off-pump coronary artery bypass grafting. Methods: A total of 421 consecutive acute myocardial infarction patients without cardiogenic shock who underwent isolated off-pump coronary artery bypass grafting were enrolled in this retrospective observational propensity score–matched analysis study. Patients who received intra-aortic balloon pump before off-pump coronary artery bypass grafting (the intra-aortic balloon pump group, n = 157) were compared with those who had not (control group, n = 264). The 30-day postoperative survival, postoperative complications, and postoperative hospital length of stay were compared between the two groups. Results: A total of 99 pairs of patients were matched. The preoperative intra-aortic balloon pump did not show a 30-day postoperative survival benefit compared with the control group (hazard ratio, 0.9; 95% confidence interval, 0.2-4.2; p = 0.92). Patients with preoperative intra-aortic balloon pump were more likely to have shorter postoperative lengths of stay (8 (6-11) days vs. 10 (6-15) days, p = 0.02) and decreased total days in the hospital (median days: 18.2 vs. 21.8, p = 0.02) compared to patients without balloon pumps. Conclusion: Preoperative intra-aortic balloon pump insertion in acute myocardial infarction patients without cardiogenic shock undergoing off-pump coronary artery bypass grafting improved convalescence as shown by significantly shorter postoperative lengths of hospital stay.

Objective:To investigate the relationship between serum lactate before initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and in-hospital mortality in adult patients with postcardiotomy refractory cardiogenic shock (PCCS).Methods:We analyzed 144 consecutive adult patients with PCCS received VA-ECMO support between January 2004 and December 2017. Patients were divided into two groups according to the serum lactate level before initiation of xVA-ECMO: low lactate group (LG, 54 cases) and high lactate group (HG, 90 cases). VA-ECMO support parameters and clinical outcomes were compared between the two groups.Results:92 (63.9%) patients were successfully weaned off VA-ECMO, and 52 (36.1%) were discharged. The inotrope scores, sequential organ failure assessment (SOFA) score at VA-ECMO initiation, and renal failure requiring renal replacement therapy during VA-ECMO support in patients with high lactate level were statistically higher ( P<0.05). The successfully wean off VA-ECMO (53.3% vs. 81.5%) and survival to discharge (16.7% vs. 68.5%) was significantly lower among patients in the HG group ( P<0.05). In multivariate analysis, high lactate levels before initiation of VA-ECMO remained the independent predictor of survival (odds ratio 11.9, 95% confidence interval 2.9-48.0, P<0.05). Conclusion:High lactate level(>8.6 mmol/L) before initiation of VA-ECMO is independently related to in-hospital mortality in adult patients with delayed refractory PCCS. This found may help clinicians to use VA-ECMO more effectively for those patients.

Objective To analyze the prognostic factors of extracorporeal membrane oxygenation(ECMO) in patients with delayed post-cardiotomy cardiogenic shock(PCCS).Methods A total of 144 adult patients with PCCS receiving ECMO in Beijing Anzhen Hospital,Capital Medical University from January 2006 to December 2016 were retrospectirely analyzed.According to the in-hospital outcomes,they were divided into survival group (n =52) and death group (n =92).Basic data,comorbidities,major surgical procedures,records of ECMO,complications,consumption of blood products and postoperative recovery were analyzed.Results Among the 144 patients,92 patients (63.9％) weaned from ECMO and 52 patients (36.1％) survived.Compared with survival group,the elderly(≥65 years old),valve replacement and valvuloplasty took higher ratios in death group [30.4％ (28/92) vs 15.4％ (8/52),38.0％ (35/92) vs 19.2％ (10/52)];patients with coronary heart disease and coronary artery bypass grafting took lower ratios in death group [42.4％ (39/92) vs 59.6％ (31/52),32.6％ (30/92) vs 50.0％ (26/52)] (all P ＜ 0.05).Incidences of limb ischemia,renal function failure required continuous renal replacement therapy(CRRT),severe neurological complication and sepsis in death group were higher than those in survival group[14.1％ (13/92) vs 0,79.3％ (73/92) vs 15.4％ (8/52),28.3％ (26/92) vs 3.8％ (2/52),31.5％ (29/92) vs 15.4％ (8/52)] (all P ＜ 0.05).Length of hospital stay in death group was shorter than that in survival group [21 (16,28) d vs 31 (21,43) d,P ＜ 0.001].Multivariate logistic regression analysis suggested that renal function failure required CRRT and severe neurological complication were risk factors of death in patients with PCCS undergoing ECMO(odds ratio =0.05,0.04;95％ confidence interval:0.01-0.22,0.01-0.28,both P ＜ 0.05).Conclusions ECMO can provide effective circulation support for patients with PCCS.Renal failure and severe neurological complication are death factors in PCCS patients undergoing ECMO.Active prevention of complications during ECMO is an important measure to improve the clinical unit.

目的 对比分析接受非体外循环冠状动脉旁路移植术(OPCAB)或体外循环下冠状动脉旁路移植术(ONCAB)患者外周血T淋巴细胞亚群、中性粒细胞与淋巴细胞比值(NLR)的变化差异.方法 通过前瞻性研究纳入40例行OPCAB或ONCAB(每组各20例)手术的患者,在术前、术后即刻及术后1 d、2 d、3 d和4 d采集外周血,采用流式细胞仪检测T淋巴细胞亚群比例、计数、粒细胞及NLR的动态变化.结果 与基线相比,OPCAB手术后T淋巴细胞亚群数目明显下降,术后3 d逐渐恢复;在围手术期间不同时间点ONCAB及OPCAB两组患者术后T淋巴细胞亚群计数和NLR变化无显著性差异.结论OPCAB引起患者外周血中性粒细胞大量增多,T淋巴细胞大量减少,ONCAB并未加重对患者T细胞各亚群及NLR的影响.

Objective To identified the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on survival and neurologic outcome in adults with refractory in-hospital cardiac arrest (IHCA).Methods All 74 adult patients who underwent ECPR for IHCA were enroued from July 2012 to December 2017 in Beiing Anzhen Hospital,Capital Medical University.Survival to discharge and cerebral performance category (CPC) scale were evaluated.The independent high-risk factors were determined using multivariate regression analysis models.Results Patients were discharged alive with favorable neurologic outcomes (CPC 1-2).Compared with patients in the SG group,the value of blood gas pH and extracellular residual alkaloids in the DG group were statistically lower (with P values below 0.05).The incidence of renal function failure requiring continuous renal replacement treatment (CRRT) and severe neurological complications were statistically higher in DG group patients.Multivariate regression analysis suggested that advanced age (age ≥ 65 years),renal function failure requiring CRRT,and severe neurological complications were independent high-risk factors for hospital death.Conclusions ECMO can provide stable hemodynamic support to inhospital cardiac arrest patients and save the lives of some patients.ECMO should be actively implanted when the cause of cardiac arrest is expected to be recoverable.

BACKGROUND:Cardiopulmonary bypass (CPB) during open-heart surgery triggers an inflammatory response that can cause significant morbidity and mortality. Human monocytes and regulatory T (Treg) cells are phenotypically and functionally heterogeneous and have been shown to play a significant role in the inflammatory dysfunction triggered by CPB. Glucocorticoids (GCs) have been widely administered for decades in patients undergoing CPB to reduce this inflammatory response. However, it has not been clearly established how routine prophylactic administration of glucocorticoids (GCs) affects monocyte and Treg subsets.METHODS:Thirty-six patient who underwent heart surgery with CPB were randomly assigned to a methylprednisolone group (MG, N = 18; 500 mg in the CPB priming) and a non-methylprednisolone group (NMG, N = 18). The circulating monocyte and Treg subsets were analyzed by flow cytometry.RESULTS:The MG and NMG groups had comparable percentages of monocyte subsets and similar expression levels of HLA-DR, CD86, CD64 and toll-like receptor 4 (TLR4). Remarkably, methylprednisolone increased the percentage of CD4+CD25+ Treg cells among CD4+ T cells in patients undergoing CPB, but did not increase the proportion of suppressive Treg cells, either resting or activated, in these patients undergoing CPB.CONCLUSIONS:Our results showed that prophylactic administration of methylprednisolone neither decreased the percentages and counts of inflammatory monocyte subsets nor did it induce the expansion of suppressive Treg cells in patients undergoing CPB. These results clarified the effects of GCs on cell-mediated immune responses and provided additional evidence in practice.TRIAL REGISTRATION:Clinicaltrials.gov : NCT01296074. Registered 14 February 2011.

Objective To analyze the impact of age on outcomes in adult patients who underwent venoartieral extracorporeal membrane oxygenation (VA-ECMO) support for postcardiotomy cardiogenic shock (PCCS).Methods Totally 496 adult patients with PCCS who were implanted with VA-ECMO from September 2006 to December 2016 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed.The patients were divided into non-elderly group (18-＜ 65 years old,n =354) and elderly group (≥ 65 years old,n =142).Clinical characteristics,comorbidities,major cardiac procedures,pre-ECMO conditions,weaning and survival from VA-ECMO,ECMO-related complications and postoperative outcomes were assessed.Results The elderly group had significantly higher prevalences of comorbidities including hypertension,hyperlipidemia,coronary heart disease,intra-aortic balloon pump support,surgical history of pulmonary embolism and lower body length (P ＜ 0.05).Weaning from VA-ECMO was achieved in 62.4％ (221/354) of the non-elderly group and 49.3％ (70/142) of the elderly group;survival to discharge was 42.4％ (150/354) among the non-elderly group and 21.8％ (31/142) among the elderly group;the elderly group had a higher incidence of renal function dysfunction requiring continuous renal replacement therapy (CRRT) [44.1％ (156/354) vs 61.3 ％ (87/142)] (x2 =12.013,20.786,11.376;P =0.007,＜ 0.001,0.001).Adverse events including infection,re-exploration for bleeding,severe neurologic complication and severe limb ischemia were comparable in both groups (P ＞ 0.05).Multivariable logistic regression identified that advanced age,renal function dysfunction requiring CRRT,severe neurologic complication and severe limb ischemia were risk factors of in-hospital mortality in adult PCCS patients supported by VA-ECMO (odds ratio =3.38,9.65,11.08,6.14;95％ confidence interval:1.49-8.10,2.75-21.20,3.69-25.79,2.48-16.51;P=0.015,＜0.001,＜0.001,＜0.001).Conclusion VA-ECMO support can be used in adult patients with PCCS with acceptable adverse events.Some elderly patients can benefit from VA-ECMO but advanced age is a risk factor of in-hospital mortality.