Severe trauma can result in severe respiratory and circulatory failure with a high mortality rate,which is quite difficult for clinical treatment. In recent years,the application of extracorporeal membrane oxygenation(ECMO)to circulatory and/or respiratory failure caused by severe trauma has received more and more attention. Systemic anticoagulation is often considered as a relative contraindication to ECMO therapy in patients with severe trauma who are at higher risk of bleeding. However,recent studies have shown that venovenous(VV)-ECMO is safe and feasible for treatment of severe acute respiratory failure after trauma,and venoarterial(VA)-ECMO is of great value for treatment of cardiogenic shock and traumatic cardiac arrest. The issues such as the timing of application,anticoagulation strategies,impact on survival and risk-benefit evaluation related to ECMO application to trauma care need to be investigated further. In this study,the authors summarize advances in application of ECMO,prevention and management of related complications in patients with severe trauma,so as to provide a reference for improving the application level of ECMO.
目的 探讨急诊科结构化护理团队对体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)患者急救效果的影响.方法 将我院急诊科56名护士分为7个结构化团队,完成急诊科结构化护理团队培训和考核.回顾性分析2018年8月—2019年12月我院急诊科实施结构化护理团队以来收治的12例ECPR患者的临床资料,包括一般资料、患者诊断、物资准备时间、管路预充时间、患者心搏骤停至体外膜肺氧合(extracorporeal membrane oxy-genation,ECMO)建立时间、ECMO支持时间、是否撤机以及患者预后等.结果 急诊科结构化护理团队实施以后,患者心搏骤停至ECMO建立时间由1.5 h缩短至最快24 min完成;急诊滞留时间由4.5 h缩短至1.5 h.结论 急诊科结构化护理团队能够减少患者心搏骤停至ECMO建立时间,缩短患者急诊科滞留时间.