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In the busy intensive care unit of the First People's Hospital of Chenzhou City, the urgent telephone rings...
"Hey! icu district one? Patients in the external circulation group are in dire need of ecmo support."
"Okay! Let's go! ”
Hang up the phone, immediately notify the department director Cai, ecmo team medical staff complete the collection in ten minutes.
Dai Xingui, deputy director of the department, led the department ecmo medical team member Kwong Daibin deputy chief physician, Li Qiong chief physician, Lu Liqi in charge of nurses, and Zhang Huiyan in charge of nurse division and cooperation.
In the shortest possible time to complete the distribution pipeline, installation, pre-charging, preoperative conversation and communication, at this moment everyone understands that "time is life, we need to race against death".
Everything is ready, and this will be the first time that the department has completed more than fifty ECMO operations, and the first time ecmo has been brought into the operating room to assist in the operation.
The patient's chest is open, and the heart under direct inspection is beating laboriously, as if to tell that it is in urgent need of support.
Deputy Chief Physician Kwong Dai-bin was decisive and skillful in operation, and after 5 minutes, the femoral vein and femoral artery ecmo pipeline were established.
With the tacit cooperation of the medical team, the ecmo pipeline was established after 20 minutes, and after half an hour, the machine began to turn around, and the nurse in the operating room lowered the support of body fluid circulation, and the patient's blood pressure and heartbeat gradually improved.
With the support of ecmo, the team of chief physician Li Yijun of Thoracic and Cardiac Surgery quickly proceeded to the next step of surgery.
The ecmo team members also breathed a temporary sigh of relief, but this is only the first step in the rescue process, and the follow-up medical staff will soon face greater challenges.
Vital signs of the patient when entering the operating room
After an hour and a half, the patient was transferred to the intensive care unit under the supervision of anesthesiologist, icu physician, thoracic surgeon and surgical nurse.
As the chief physician, Dr. Li Qiong, knew that she was about to face a hard battle.
The first is the patient's bleeding level, followed by the patient's recovery of cardiac function.
Unsurprisingly, in the first hour after surgery, the patient's right chest cavity closed drainage tube and pericardium mediastinal drainage tube drained out about 300 ml of bright red bloody fluid per hour, and in 24 hours, the patient drained about 3800 ml of hemorrhagic fluid and about 3600 ml of supplemental blood products.
This number may not be much for the average surgeon, who is faced with a patient with an ejection fraction of only 11% (normal people generally have an ejection fraction of about 55%).
This requires strict liquid management, and the amount of inflow and out per hour must be balanced.
The more fluid enters the body, the more vulnerable the heart will be unable to bear it;
Too little fluid is injected, and the patient's blood pressure cannot be maintained, which requires medical workers to stay at the bedside for 24 hours a day to monitor and observe.
Finally, in the afternoon of the next day, the color of the drainage fluid in the patient's pericardial drainage tube gradually faded, and the amount of drainage fluid also decreased.
On this basis, the medical staff tried to remove the patient's endotracheal intubation.
The goal is to hope that the patient will cough and cough sputum on his own, eat independently, and carry out rehabilitation exercises as soon as possible.
Everything seems to be proceeding step by step, and when it is thought that only need to wait for the patient's cardiac function to recover, the patient develops severe hypoxemia on day 3, and the partial pressure of blood oxygen in the high-flow oxygen state (oxygen concentration 100%) is only 56 mmhg, and the oxygenation index is less than 100.
Under the guidance of Chief Physician Cai Yeping, the head of the department, he did not choose to intubate the trachea again, but used another non-invasive positive pressure ventilation, and asked Dr. Zhang Rijing of the Rehabilitation Department to guide the patient at the bedside how to breathe deeply in a state of reducing the pain of the chest wound and early lung rehabilitation exercises.
On the 4th day after the operation, the patient's respiratory status improved significantly, and the daily cardiac ultrasound continued to bring good news.
The patient's ejection fraction ranged from 11% at the beginning to 18% on the second day and 28% on the third day, and the patient's heart function continued to improve.
On the 5th day, the patient was successfully evacuated from ecmo and non-invasive ventilator with the help of Deputy Chief Physician Fan Xiaowen of the Department of Vascular Surgery, and on the 7th day after the operation, he was smoothly transferred back to the general ward for continued treatment.
In this battlefield without smoke, ecmo instruments need 24 hours of uninterrupted operation, so medical staff must observe the operating status of the equipment 24 hours a day and monitor the patient's vital signs and coagulation function, adjust the internal environment according to the patient's blood gas value, and ensure the stability of the internal environment.
At present, the in vitro life support technology of the first people's hospital of Chenzhou City is becoming more and more mature, ecmo is a weapon in the department of intensive care medicine, is the last straw to protect life, it redefines the boundary between life and death.
(Edit zebra.) Some of the image sources of the network, invasion and deletion)
Hunan Medical Chat Special Author: Li Qiong, The First People's Hospital of Chenzhou City Pay attention to @Hunan Medical Chat for more health science information!