目的 观察一种离线血袋超滤装置处理体外循环(CPB)余血回输方式对患者的回收作用,为心脏术后选择合理的余血回输模式提供参考依据并观察其临床疗效.方法 用输血袋、超滤器、6mm连接管路、6×6两通接头、废液袋组成血袋超滤装置,将体外循环结束后的余血全部打入血袋超滤装置,经循环超滤后回输给患者.选择2019年3月至2020年3月于邯郸市第一医院心外科在CPB下行心脏手术患者75例,其中男性46例,女性29例;年龄20-70岁,平均年龄52.73岁(标准差12.39岁);身高155-178 cm,平均身高168.40 cm(标准差7.39 cm).观察择期体外循环心脏手术患者机血不同处理前后变化及回收效果,分为血袋超滤组、离心/洗涤组及环路超滤组,每组各25例.比较各组机器余血处理后血红蛋白(Hb)、红细胞压积(HCT)、血小板计数(Plt)、总蛋白、白蛋白、纤维蛋白原(FIB)计数变化;观察回输机血量、机械通气时间、24 h胸引量、重症监护病房(ICU)停留时间、输余血2 h后Hb和HCT、接受异体血量.结果 血袋超滤回收余血后Hb、HCT、Plt计数、总蛋白、白蛋白、FIB均有所提高,与处理前比较差异有统计学意义(P＜0.05);机体回输经血袋超滤处理的机血后Hb、HCT较停机时有所提高,与停机时比较差异有统计学意义(P＜0.05),术后没有相关并发症.血袋超滤组处理后 Hb、HCT、Plt、总蛋白、白蛋白、FIB高于环路超滤组,差异有统计学意义(P＜0.05).血袋超滤组处理后Plt、总蛋白、白蛋白、FIB高于离心/洗涤组,差异均有统计学意义(P＜0.05);Hb、HCT两组比较,差异无统计学意义(P＞0.05).3组术后机血回收量及其他临床结果比较,差异无统计学意义(P＞0.05);离心/洗涤组接受血浆量高于其他两组,差异有统计学意义(P＜0.05).术后无相关并发症.结论 停机后血袋超滤可以顺利完成对体外循环余血的浓缩并回输患者,患者可获得较高、更稳定浓度的Hb、HCT、血浆及最佳状态蛋白和凝血因子的血液,是一种安全的术后余血回收方式.

报道2例右上腔静脉缺如伴永存左上腔静脉、房间隔缺损的病例。病例1术中偶然诊断；据此经验，病例2术前应用对比增强计算机断层血管造影明确解剖诊断。2例体外循环分别采用了不同的静脉置管策略，病例2同时存在右心耳血栓形成，术中予以清除。

The mortality of severe asthma with cardiac arrest is still close to 100% even if it is treated with conventional cardiopulmonary resuscitation (CCPR). Extracorporeal cardiopulmonary resuscitation (ECPR) has been widely accepted as an alternative method when CCPR is futile. However, the maximum “low-flow” duration has not been well defined. Here, we reported a 55-year-old male with severe asthma with cardiac arrest, who was successfully treated with ECPR after 100 min of ultra-long CCPR. He was withdrawn from extracorporeal membrane oxygenator and ventilator at 72 h and 14 days after admission respectively and was discharged without permanent neurologic sequelae. This case illustrates the critical role of ECPR as a last resort in near-fatal asthma. For such patients with bystander, starting ECPR after >60 min of CCPR can still obtain satisfactory prognoses.

心脏自主神经系统主要涵盖两个方面,即外源和内源自主神经系统;其中神经丛作为整个内外心脏自主神经系统的核心部位,一直处于动态平衡的调控中,任何的某个环节出现失衡就会引起心脏电生理的整体性改变,从而诱发心房颤动的发生.对于自主神经系统的整体调控来说,在心房颤动的发生和维持中起着至关重要的作用.目前有众多方法可调节心脏和自主神经的相关关系,并对心房颤动起到了不同的影响.文章通过对自主神经系统解剖基础、作用机制及消融的方式进行阐述,进一步证实此手段可以作为一种辅助或者独立的手术形式来治疗阵发或者长期心房颤动,并为治疗心房颤动提供了最新的研究和发展方向.最近一些研究主要围绕着对自主神经系统多个方面进行刺激甚至消融,然而自主神经系统对心房颤动影响的综合机制等情况尚不能完全阐述.因此,随着国内外研究的不断深入,自主神经网络的调控可能为心房颤动患者治疗提供了新的方法和思路,也是该领域下一步的研究目标.

Circular RNAs (circRNAs), a novel class of endogenous long non-coding RNAs, have attracted considerable attention due to their closed continuous loop structure and potential clinical value. In this study, we investigated the function of circFASTKD1 in vascular endothelial cells. CircFASTKD1 bound directly to miR106a and relieved its inhibition of Large Tumor Suppressor Kinases 1 and 2, thereby suppressing the Yes-Associated Protein signaling pathway. Under both normal and hypoxic conditions, the ectopic expression of circFASTKD1 reduced the viability, migration, mobility and tube formation of vascular endothelial cells, whereas the downregulation of circFASTKD1 induced angiogenesis by promoting these processes. Moreover, downregulation of circFASTKD1 in mice improved cardiac function and repair after myocardial infarction. These findings indicate that circFASTKD1 is a potent inhibitor of angiogenesis after myocardial infarction and that silencing circFASTKD1 exerts therapeutic effects during hypoxia by stimulating angiogenesis in vitro and in vivo.

近来对经皮去肾动脉交感神经消融术治疗顽固性高血压初步研究表明,肾动脉交感神经射频消融术可有效降低血压.然而,第一个随机假手术对照试验,Symplicity-HTN-3显示,与假手术组相比,诊室血压或24h动态血压没有明显降低.随后在动物和人类身上的研究证实了更多远端和分支肾动脉射频消融术的潜在重要性.最近两个随机假手术对照试验在不服用抗高血压药物(SPYRAL HTN-OFF MED)或继续服用药物(SPYRAL HTN-ON MED)的患者中进行了肾动脉消融术,这两项研究均使用了第二代射频消融系统.这些研究表明,与假手术组相比,肾动脉消融术可显著降低诊室血压和24 h动态血压.另一项最近在未接受药物治疗的患者中进行的随机假手术对照试验表明,与假手术相比,仅在主肾动脉应用导管超声(RADIANCE-HTN SOLO)的肾动脉消融术显著降低了白天的动态血压和诊室血压.这些试验重新引起了临床和科学界对确定肾动脉消融术在高血压治疗中的适当作用的兴趣.此外,未来还需要解决其他重要问题,如确定手术时肾动脉消融的深度、消融靶点的数量、消融的持续时间及在消融术后后期肾神经纤维恢复通畅的可能性.文章主要对经皮去肾交感神经消融术治疗顽固性高血压的基本情况及其研究现状作一综述.

Constrictive pericarditis in children is exceedingly rare, and may cause very problematic confusion of diagnosis and etiology identification. In this case, we examined a 14-year-old female patient who had developed signs of significant anasarca which was eventually turned out to be constrictive pericarditis. Affected by the experience of examiners, the patient was not diagnosed or even suspected with constrictive pericarditis when she was initially examined by echocardiography in the hospital where she visited before. Reexamination of echocardiography, cardiac catheterization and non-invasive image techniques were performed to establish the diagnosis finally. Open pericardectomy was ultimately performed and normal hemodynamic parameters and cardiac function were obtained postoperatively. In the determination of etiology, we inferred that chronic infection induced by local virus infection in the pericardium led to constrictive pericarditis. Parvovirus B19 (PVB19) and/or human herpes virus 6 (HHV-6) were the two most likely viruses involved based on published literature reviews. Importantly, we learned that serological antibody testing may be false-negative and polymerase chain reaction (PCR) or metagenomic next-generation sequencing for pericardial viral nucleic acid testing may be the gold standard for confirmation. Unfortunately, fresh pericardial tissue samples were not taken before paraformaldehyde fixation in our case, which made it impossible for us to detect suspicious viruses. We do hope that the lessons learned from this case will be helpful and instructive for the etiological diagnosis of similar patients in the future.

体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)技术主要用于重症心肺功能衰竭的患者的高级生命支持.ECMO在治疗病毒性肺炎、重症感染等多种病因导致心肺损伤后呼吸循环衰竭患者降低患者死亡率方面,比机械通气等传统方法更具优势.ECMO作为肺移植患者术前过度期的一种桥接策略,使得潜在肺部疾病的恶化不应再成为自动取消考虑移植资格的理由,挑战了通气或体外循环支持是肺移植禁忌症的观点.除了在患者应用ECMO前采用PRESERVE评分和RESP评分进行预后评估,还可以通过应用ECMO治疗过程中,机体中的代谢产物的指标或变化趋势来预测患者的预后.

Severe acute respiratory distress syndrome (ARDS) is commonly seen in intensive care units (ICUs). It is characterized by capillary endothelium and alveolar epithelium damage that results in significant increases in capillary permeability and extravascular lung water. It is difficult to quantify pulmonary edema accurately using conventional imaging. Pulse index continuous cardiac output (PiCCO) is a parameter based on transpulmonary thermodilution that overcomes these shortcomings. Several measurements derived from PiCCO can be determined continuously and accurately, including extravascular lung water index (ELWI), and pulmonary vascular permeability index (PVPI). Several prospective studies have demonstrated that early goal-directed treatment (EGDT) according to these measurements can help with volume management and ultimately reduce the in-hospital mortality rate in critically-ill patients.[1] For patients with severe ARDS with oxygenation indexes less than 100 mmHg, extracorporeal membrane oxygenation (ECMO) can improve oxygenation without adding average alveolar pressure. Because of the existence of pulmonary edema in these patients, it is necessary to accurately measure ELWI and PVPI in a timely manner during treatment, and to tailor treatment to improve outcomes. Nevertheless, blood volumes and circulation patterns change during ECMO, and the reliability and prognostic value of the parameters obtained using PiCCO are controversial and lack evidence-based support. Therefore, the aim of the present study was to comprehensively analyze the clinical value of hemodynamics obtained by PiCCO in adults with severe ARDS assisted by ECMO at our center. The ethics committee of Tianjin Third Central Hospital approved the study protocol (No. IRB2020-012-01) and all patients or their family members provided informed consent forms for participation in the study. The inclusion and exclusion criteria were described previously.[2,3] When measuring PiCCO parameters, we paused the running of ECMO. Ten milliliters of cold saline (0–6°C) were then injected quickly (less than 5 s) from the right internal jugular vein catheter. The thermistor tip of the femoral artery catheter was to measure temperature changes downstream. Every measurement was repeated three times and the average was taken as the final result. The measurement was taken at least twice a day. Quantitative data were expressed as mean ± standard deviation or median (interquartile range), and categorical data were expressed as numbers and proportions. The independent sample's t-test and Chi-square test were applied for comparison of data between groups. For multiple longitudinal comparisons of data, one-way analysis of variance with repeated measures and the least significant difference post-hoc analysis were used. Correlations between PVPI and ELWI and between ELWI and survival outcome were evaluated with Spearman correlation analysis. Receiver operating characteristic (ROC) curve was used to assess a variable's capacity to predict the outcome of survival. Kaplan-Meier survival analysis was utilized to measure differences in cumulative survival rates. SPSS 23.0 (SPSS Inc., Chicago, IL, USA) was used for statistical analyses. All two-sided P values were considered to be statistically significant if P < 0.05. The data from 30 adults with ARDS managed with ECMO in our hospital from January 2008 to December 2018 were comprehensively reviewed. The age range was 20 to 74 years and the mean age was 44.7 ± 20.3 years. Twenty-six were male. There were no significant differences between survival (18 patients) and non-survival groups (12 patients) with respect to age, gender, comorbidities, Acute Physiology and Chronic Health Evaluation II/sequential organ failure assessment score, treatment strategies, volume of blood product transfusion, ECMO-related complications, lengths of ICU stay, or in-hospital stay (all P > 0.05) [Supplementary Table 1, http://links.lww.com/CM9/A333]. However, the maximum dosage of norepinephrine before ECMO establishment in the non-survival group was significantly higher than that of the survival group (0.6 [0.4, 5.0] μg·kg−1·min−1vs. 0.5 [0.3, 2.8] μg·kg−1·min−1, Z = –2.198, P = 0.026). There was a tendency for longer length of mechanical ventilation before ECMO support in the non-survival group than in the survival group (24.0 [4.0, 120.0] h vs. 9.0 [3.0, 47.5] h, P = 0.088). The time points of data acquisition included immediately (T0), 24 h (T24 h), 48 h (T48 h), 72 h (T72 h), and 1 week (T1 w) after catheterization. The evolution characteristics showed that the ELWI value of the survival group decreased significantly after treatment (P-trend < 0.001). The comparison of the data at various time points within the survival group demonstrated that the ELWI values at 24 h, 72 h, and 1 week after catheterization were significantly lower when compared to that of the initial time point (T0) after treatment [Supplementary Table 2, http://links.lww.com/CM9/A333]; this was not observed in the non-survival group. The results of inter-group comparisons showed that the ELWI values at 72 h (10.7 ± 3.7 mL/kg vs. 17.3 ± 4.5 mL/kg, P = 0.006) and 1 week (9.1 ± 2.9 mL/kg vs. 14.3 ± 4.0 mL/kg, P = 0.027) in the survival group were significantly lower than those of the non-survival group. The PVPI in the survival group also demonstrated a downward trend after treatment despite no statistical significance (P-trend = 0.122). There was no such decline in the non-survival group (P-trend = 0.725). The results of intergroup comparisons showed that the PVPI values at 72 h (2.3 ± 0.6 vs. 3.4 ± 1.2, P = 0.008) and 1-week (2.0 ± 0.6 vs. 2.6 ± 0.8, P = 0.041) in the survival group were significantly lower than those of the non-survival group. The ELWI and PVPI values showed a significant linear correlation at both 72 h (r = 0.950, P < 0.0001) and 1 week (r = 0.834, P < 0.0001). No significant differences were found in terms of other PiCCO parameters on intra-group or inter-group comparisons at each time point. ROC curve analysis was conducted for ELWI at various time points to measure the discriminative performance for survival to discharge. ELWI at T72 h had the best discriminating performance for survival to discharge, and the area under curve was 0.900 (95% confidence interval [CI]: 0.699–1.101; P = 0.043). The cutoff value was 12.5 mL/kg with 100% sensitivity and 70% specificity [Supplementary Table 3, http://links.lww.com/CM9/A333]. Spearman correlation analysis showed that ELWI at T72 h significantly correlated with survival to discharge (r = 0.632, P = 0.015). The patients were reclassified based on the cutoff of ELWI (12.5 mL/kg) and Kaplan-Meier survival analysis was performed in patients with the value of ELWI at T72 h less than 12.5 mL/kg (n = 16) and no less than 12.5 mL/kg (n = 14). A significant difference in cumulative survival rates was observed between the two groups (log-rank test: χ2 = 5 .241, P = 0.022; hazard ratio, 5.82, 95% CI: 1.90–17.86). Implementation of ECMO requires highly specialized teams, and consumes a great deal of human and medical resources. One of the key points to improve success rate is to assess the individualized characteristics of pulmonary edema and to adopt EGDT. It is crucial to identify safe and effective monitoring indexes to assist with accurate fluid management. Compared to the conventional chest imaging, the ELWI and PVPI obtained from PiCCO directly reflect the amount of extravascular lung water and permeability of pulmonary capillaries, providing the possibility to quantify the physiological changes in the patients in a timely and dynamic manner. In this study, we found that the ELWI values at each time point in the non-survival group were all significantly higher than those of the survival group, especially at 72 h and one week. This is consistent with our early treatment experience of adults with ARDS who were not managed with ECMO.[4] The value of ELWI in the survival group decreased significantly as the treatment progressed, and this was not seen in the non-survival group. The inflection point where the ELWI began to decrease in the survival group was earlier than that of the non-survival group (48 h vs. 72 h). This finding suggests that it may be valuable to predict outcome by comprehensively analyzing the dynamic evolution of ELWI value within one week. For ECMO-assisted patients with severe ARDS, blood volume and circulation patterns change during extracorporeal cardiopulmonary bypass. The reliability of using PiCCO to monitor hemodynamics in the scenario was once questioned and its prognostic value remains without evidence-based support. Previous studies have shown that measurements of ELWI obtained by PiCCO in ARDS patients seem not to be significantly affected by an extracorporeal bypass under the premise that the flow of a pumpless lung-assist system does not exceed 20% of cardiac output.[5] For our patients, we paused extracorporeal circulation when we collected the PiCCO measurements and limited the total time of the parameter acquisition to five minutes. We found no significant hemodynamic fluctuations in any patient during the acquisition of PiCCO data, and the variability of data by triple-repeated measurement was comparable to that of our ARDS adults without ECMO assistance. PVPI demonstrated similar dynamic evolution, and also had certain value to predict the prognosis. Nevertheless, no statistical significance was found in respect of the overall change trend of PVPI in the survival group. This may be due to the following reasons: First, although PVPI is derived from ELWI, the correlation between them was not shown strong in some studies, suggesting that they may have different pathophysiologic significance. Second, PVPI may be influenced by factors such as lymphatic drainage and the alveolar fluid clearance rate. Third, all patients in our study received various types of anti-inflammatory treatments (such as corticosteroids) that may reduce the degree of endothelial cell injury to some extent. Finally, there were limitations of sample size on statistical power. In conclusion, PiCCO can be used for volume monitoring during ECMO assistance in severe ARDS patients. ELWI and PVPI at 72 h after PiCCO establishment may facilitate to predict their intra-hospital survival. Funding This work was supported by the grants from Science and Technology Fund of Tianjin Health Bureau (No. 2015KZ015), the Tianjin Third Central Hospital National Natural Science Foundation Incubation Project of China (No. 2019YNR1), and the Natural Science Foundation of Tianjin (No. 19JCYBJC2600). Conflicts of interest None.

目的 总结体外膜肺氧合(ECMO)支持重症呼吸衰竭患者院间转运的经验,提高ECMO救治率.方法 总结2013年1月至2018年10月19例静脉-静脉(V-V)ECMO支持的重症呼吸衰竭患者院间转运的模式、流程、并发症及管理经验.结果 19例患者均安全转运,其中1例转运过程中出现低氧血症.入院后救治成功8例,9例出现不可逆的多脏器衰竭而死亡,1例因循环不能维持死亡,1例出现无法控制的腹膜后出血死亡,救治成功率8/19.结论 在ECMO转运过程中合理的人员配置、充分的物品准备、适宜的车辆空间安排及转运人员之间密切的配合是提高转运安全性、稳定性及ECMO救治率的关键.

Objective To summarize the experience and therapeutic effect of extracorporeal membrane oxygenation (ECMO) combined with catheter-based intervention in high risk acute pulmonary embolism(APE). Methods Along with ventilator support, 4 patients with high-risk APE were treated by ECMO combined with catheter-based intervention in our hospital from August 2014 to November 2016.3 patients were in cardiac arrest at the time of admission, and 1 patient was in the state of cardiac shock,both of which were supported with cardiopulmonary resuscitation,ventilation and ECMO assistance. Both of them underwent catheter-based intervention after diagnosis with APE.2 patients underwent mechanical fragmentation, thrombolytic therapy, 2 patients underwent mechanical fragmentation therapy,and 1 patient suffered from rupture bleeding of a branch of the internal thoracic artery and underwent embolization therapy during the same period. Results 2 patients did not discharged from ECMO and died after removed ECMO.2 patients were successfully discharged from ECMO and ventilator support.1 of them died with multiple organ failure, and 1 case had no obvious complications, and showed a good follow-up observation. Conclusion ECMO combined with catheter-based intervention provides an effective treatment for patients with high-risk APE,with a good clinical treatment effect.

Objective To compare the perioperative characteristics and long term outcomes between extracorporeal membrane oxygenation (ECMO)-conventional cardiopulmonary switch (experimental group,26 cases) and off-pump high-risk coronary artery bypass grafting (OPCABG group,24cases).Methods Perioperative characteristics and survival rate were retrospectively analyzed between experimental group and OPCABG group.Long term survival rates without major cardiovascular adverse events (MACE) were comparatively analyzed via Kaplan-Meier curves.Results The average Euroscore value were 11.7 ± 2.4 and 10.9 ± 2.0,respectively(P =0.208).The experimental group had a higher complete revascularization rate (96.2％ vs.66.7％,P =0.009),a shorter length of postoperative ECMO support [(33.1±23.6)h vs.(80.8±18.5)h],an intensive care unit stay[(4.8±1.1)d vs.(10.2±9.0)d]and a hospital stay [(17.7±6.3)d vs.(28.2±17.5)d] (all P＜0.05) as compared with OPCABG group.Preoperative New York Heart Association (NYHA) grading of cardiac function (r =0.511,P =0.008) and intraoperative ultrafiltration volume (r =-0.442,P =0.024) were significantly correlated with postoperative ECMO continuation in the experimental group.The follow-up period was (45.4 ± 15.2) months.The experimental group had a higher survival rate without MACE than had the OPCABG group (Log-rank test:x2=4.828,P=0.028).Conclusions The ECMO-conventional cardiopulmonary switch mode might facilitate a higher complete revascularization,a lower incidence of postoperative morbidities and improve the longterm survival rate without MACE for patients with high risks.

BACKGROUND This study was designed as an external evaluation of potentially relevant models for acute myocardial infarction (AMI) with extracorporeal cardiopulmonary resuscitation (E-CPR). MATERIAL AND METHODS Twenty AMI adults that met criteria were retrospectively analyzed from January 2009 to January 2015. Six possible models - ENCOURAGE, SAVE, ECPR, GRACE, SHOCK, and a simplified risk chart - were identified by literature review and model scores calculated based on original data. Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment, commonly used in intensive care units, served as controls. A receiver operating characteristic curve was used to compare the models' discriminative power for predicting survival to discharge. RESULTS The ECPR model showed the best discriminative performance, with an area under the curve (AUC) of 0.893 (95% confidence interval [CI], 0.733-1.530, p=0.006); the cutoff was 12.5 points, with 66.7% sensitivity and 100% specificity. The "clinical" SHOCK model (including infarct site) showed weaker but still good discriminative power, with an AUC of 0.804 (95% CI, 0.580-1.027, p=0.035); the cutoff was 45.5 points, with 83.3% sensitivity and 71.4% specificity. The remaining models did not show significant discriminative power for predicting survival to discharge. Risk stratifications indicated that a statistically significant difference was observed in the distribution of patients into the ECPR group with different prognoses when stratified by its cutoff (p=0.003), while a trend of significant difference was shown when applied to the SHOCK model (p=0.05). CONCLUSIONS The ECPR and SHOCK models possess important abilities to predict intrahospital outcomes of AMI patients treated with E-CPR.

Acute myocardial infarction (AMI) and acute massive pulmonary embolism can be characterized by no pulse electrical activity. Patients of cardiac arrest (CA) with no pulse electrical activity have a high mortality rate before the cause was corrected. Extracorporeal membrane oxygenation (ECMO), as a kind of artificial heart-lung support organ, provides treatment for CA patients. A case of massive pulmonary embolism similar to AMI was treated in the Third Central Hospital of Tianjin, who received interventional thrombolysis assisted by ECMO. Through the review of the overall development of the case, we aim to broaden the diagnosis and treatment of CA patients with no pulse electrical activity, and to improve the understanding of the complications secondary to ECMO.

Background: No definitive conclusions have been drawn from the available data about the utilization of extracorporeal membrane oxygenation (ECMO) to treat severe acute respiratory distress syndrome (ARDS). The aim of this study was to review our center's experience with ECMO and determine predictors of outcome from our Chinese center.Material/Methods: We retrospectively analyzed a total of 23 consecutive candidates who fulfilled the study entry criteria between January 2009 and December 2015. Detailed clinical data, ECMO flow, and respiratory parameters before and after the introduction of ECMO were compared among in-hospital survivors and nonsurvivors; factors associated with mortality were investigated.Results: Hemodynamics and oxygenation parameters were significantly improved after ECMO initiation. Thirteen patients survived to hospital discharge. Univariate correlation analysis demonstrated that APACHE II score (r=-0.463, p=0.03), acute kidney injury (r=-0.574, p=0.005), membrane oxygenator replacement (r=-0.516, p=0.014) and total length of hospital stay (r=0.526, p=0.012) were significantly correlated with survival to hospital discharge, and that the evolution of the levels of urea nitrogen, platelet, and fibrinogen may help to determine patient prognosis. Sixteen patients referred for ECMO from an outside hospital were successfully transported to our institution by ambulance, including seven transported under ECMO support. The survival rate of the ECMO-transport group was comparable to the conventional transport or the non-transport group (both p=1.000).Conclusions: ECMO is an effective alternative option for severe ARDS. APACHE II score on admission, onset of acute kidney injury, and membrane oxygenator replacement, and the evolution of levels of urea nitrogen, platelet, and fibrinogen during hospitalization may help to determine the in-hospital patient prognosis. By establishing a well-trained mobile ECMO team, a long-distance, inter-hospital transport can be administered safely.

Objective: To evaluate the resuscitation efficacy of extracorporeal membrane oxygenation (ECMO) for non-postcardiotomy cardiac arrest adult patients post failed conventional cardiopulmonary resuscitation (CCPR). Methods: We retrospectively analyzed the clinical data of a total of 25 consecutive adults who suffered from non-postcardiotomy cardiac arrest and were treated with ECMO post failed CCPR in our hospital between January 2010 and January 2015. Inclusion criteria included: 18 to 75 years old; the duration from cardiac arrest to CCPR initiation<5 minutes; no recovery of spontaneous circulation within 10 min after implementation of standard CCPR, and the length of CCPR <90 minutes. Patients were divided into non-survival group (18 cases) and survival group (7 cases) based on their in-hospital outcome and the clinical characteristics were compared. Related factors of survival to discharge were analyzed by Spearman correlation analysis. Results: Majority of patients (84.0%(21/25)) developed cardiac arrest in our hospital, mostly due to acute myocardial infarction (80.0%(20/25)). The mean duration of CCPR prior to ECMO support was 40.0 (27.5, 72.0) minutes. The mean duration of ECMO support was 72.0 (47.5, 128.3) hours and 9 patients (36.0%) were successfully weaned. Intensive care unit stay was significantly shorter (3.0(1.8-7.8)days vs.16.0(11.0-37.0) days, P<0.01), mean blood pressure at 24 and 48 hours after ECMO initiation was significantly lower ((73.2±20.1)mmHg(1 mmHg=0.133 kPa) vs. (91.1±20.4)mmHg, P<0.05; (63.0±16.7)mmHg vs. (86.6±18.0 mmHg), P<0.05, respectively) and platelet count at 72 hours after extracorporeal support was significantly lower ((57.0±30.1)×109/L vs. (97.3±31.5)×109/L, P<0.05) in the non-survivor group than in survival group. Spearman correlation analysis demonstrated that mean arterial pressure at 24 hours (r=0.427, P<0.05) and 48 hours(r=0.558, P<0.05), and platelet count at 72 hours after extracorporeal support (r=0.577, P<0.05) were significantly correlated with survival to discharge. Conclusion: ECMO can be used as an effective alternative for refractory cardiac arrest in non-postcardiotomy adult patients.

Background: There has been no external validation of survival prediction models for severe adult respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) therapy in China. The aim of study was to compare the performance of multiple models recently developed for patients with ARDS undergoing ECMO based on Chinese single-center data.Methods: A retrospective case study was performed, including twenty-three severe ARDS patients who received ECMO from January 2009 to July 2015. The PRESERVE (Predicting death for severe ARDS on VV-ECMO), ECMOnet, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score, a center-specific model developed for inter-hospital transfers receiving ECMO, and the classical risk-prediction scores of Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) were calculated. In-hospital and six-month mortality were regarded as the endpoints and model performance was evaluated by comparing the area under the receiver operating characteristic curve (AUC).Results: The RESP and APACHE II scores showed excellent discriminate performance in predicting survival with AUC of 0.835 (95% confidence interval [CI], 0.659-1.010, P = 0.007) and 0.762 (95% CI, 0.558-0.965, P = 0.035), respectively. The optimal cutoff values were risk class 3.5 for RESP and 35.5 for APACHE II score, and both showed 70.0% sensitivity and 84.6% specificity. The excellent performance of these models was also evident for the pneumonia etiological subgroup, for which the SOFA score was also shown to be predictive, with an AUC of 0.790 (95% CI, 0.571-1.009, P = 0.038). However, the ECMOnet and the score developed for externally retrieved ECMO patients failed to demonstrate significant discriminate power for the overall cohort. The PRESERVE model was unable to be evaluated fully since only one patient died six months postdischarge.Conclusions: The RESP, APCHAE II, and SOFA scorings systems show good predictive value for intra-hospital survival of ARDS patients treated with ECMO in our single-center evaluation. Future validation should include a larger study with either more patients' data at single-center or by integration of domestic multi-center data. Development of a scoring system with national characteristics might be warranted.

Objective To summarize clinical application, method and result of extra-corporeal membrane oxygenation ( ECMO) used during beating heart coronary artery bypass grafting ( CABG) in high risk patients. Methods Twenty one patients [ mean age ( 75. 7 ± 3. 6 ) years old ] who received beating-heart CABG surgery assisted with ECMO were included in the study. We observed the condition when ECMO weaned off, the duration on mechanical rentilato time of ICU stay and the occurance of related complications. Results Among the 21 patients, ECMO was weaned off uneventfully after surgery in 8 patients. Immediate weaning was failed in another 8 patients and required gradual weaning in 2. 0-4. 5 hrs. Five patients could not wean off the ECMO in operation room needing continuous ECMO support in CCU. ECMO was weaned off in CCU gradually with IABP support [mean IABP support time: (115. 0 ± 25. 9) hrs]. Among the 5 patients admitted into CCU, 1 patient had oozing from insertion site at femoral artery/rein region and was stopped with compressive bandage. Lower limb ischemia happened in another 1 patient and was recovered after set up of by-pass circulation. All 21 patients recovered well and smoothly. Mean in-hospital stay was (17. 4 ± 2. 8) d. Conclusions ECMO is a safe and effective circulatory support during beating heart coronary artery bypass surgery for high-risk patients with severe coronary artery disease in reducing the mortality and complications.

OBJECTIVE:To evaluate the effect of extracorporeal membrane oxygenation (ECMO) combined with primary percutaneous coronary intervention (PPCI) on cardiac arrest in patients with acute myocardial infarction (AMI).METHODS:We retrospectively analyzed the clinical data from twenty cardiac arrest patients due to AMI from January 2010 to January 2015, who received both ECMO and PPCI after failed conventional cardiopulmonary resuscitation (CCPR) procedure in our center. The mean age was (58.8±13.9) years old and seventeen cases were male. The patients were divided into weaned (8 cases) and non-weaned group (12 cases) according to the outcome of ECMO removal, or survivor (6 cases) and non-survivor group (14 cases) according to the in-hospital outcome. The risk factors that affected weaning from ECMO and survival to discharge were analyzed via Spearman rank correlation test.RESULTS:(1) The mean duration of CCPR and ECMO support was (46.7±22.2)min and (102.3±66.6)h, respectively. The rate of return of simultaneous beating was 100%(20/20). (2) CCPR duration was significantly shorter ((35.1±11.8)min vs. (54.4± 24.5) min, P<0.05) and cardiac care unit(CCU) stay time was significantly longer ((20.5±12.3)d vs. (4.3±4.0)d, P<0.05) in weaned group than in non-weaned group. Moreover, a significant difference was identified in culprit vessel distribution between the two groups (P<0.05). Culprit vessel distribution (left anterior descending artery r=-0.612, P<0.01; right coronary artery r=0.612, P<0.01) and length of cardiac care unit stay (r=0.784, P<0.01) were associated with weaned patients. (3) CCPR duration was significantly shorter ((29.2±4.9)min vs. (51.0±24.5)min, P<0.01). CCU stay time was significantly longer(16.0(9.5, 37.8)d vs. 3.0(2.0, 11.0) d, P<0.01). Weaning rate (6/6 vs. 2/14, P<0.01) and mean blood pressure ((87.9±19.4)mmHg(1 mmHg=0.133 kPa) vs. (63.7±18.6)mmHg, P<0.05) were significantly higher, while lactic acid level in arterial blood((1.74±0.85)mmol/L vs. (6.41±5.65) mmol/L, P<0.05) 48 hours after ECMO support was significantly lower in survivor group compared with non-survivor group. Culprit vessel of right coronary artery (r=0.491, P<0.05), length of CCU stay (r=0.609, P<0.01), successful weaning rate (r=0.802, P<0.01), and mean blood pressure at 48 hours after ECMO establishment (r=0.558, P<0.05) were positively associated with survival.CONCLUSION:ECMO combined with PPCI is an effective therapeutic option to rescue AMI patients complicating with cardiac arrest.

Objective To analyze metabolic profile changes in serum of type 2 diabetic rat model based on ultra-performance liquid chromatography/mass spectrometry technology(UPLC/MS), and explore the difference markers. Method Thirty 2-month male Wistar rats with body weight of (150 ± 15) g were chosen and divided into control group(n = 15) and experimental group (n=15). In experimental group, the rats were fed with high-fat diet and injected with Streptozotocin (STZ) in dosage of 55 mg/kg to set up type 2 diabetic rat models. Successful models were determined by oral glucose tolerance test (OGTT). During 1 - 5 weeks after modeling, the serum was collected and metabolic profiling were analyzed using UPLC/MS. The variability of metabolic profiling data was analyzed by principal component analysis (PCA) and orthogonal partial least squares-discriminant analysis (OPLS-DA), feature ions of type 2 diabetic rats were then screened and identified. Results The blood glucose of ex-perimental group was increased after modeling, and the metabolic profiling difference between control group and experimental group increased over time (P < 0.05). Compared to control group, the lactic acid and other kinds of substance in serum of ex-perimental group changed significantly (P < 0.05). The content of lactic acid, urea, glycerin, L-isoleucine, and L-serine in-creased significantly, while the content of aminoacid, β-hydroxybutyric acid, phosphoric acid, threonine and glycerol acid de-creased. Conclusion It is demonstrated that significant changes are observed in serum metabonomics of type 2 diabetic rat model set by STZ, of which 10 kinds of substance can be used as early potential markers of type 2 diabetes.