Cardiovascular disease has become the number one disease that threatens the lives and health of the masses in our country, so it is crucial to improve the public's awareness of cardiovascular diseases and form a sense of prevention and treatment of cardiovascular diseases. To this end, on the occasion of World Heart Day on September 29, 2021, Shanghai Chest Hospital and Sina Health Aiwen Doctors presented 7 live interviews with authoritative experts from September 26 to 30 and October 8 and 9, helping the public establish a good awareness of cardiovascular disease prevention and treatment through interpretation of cardiovascular medical knowledge and on-site Q&A.
Up to now, the cumulative number of live broadcasts and replays of this series has exceeded more than 5 million, and the live broadcast playback of this live broadcast has reached 841,000, and the data is detailed in the following figure:
Sina Health Aiwen Doctor edited according to the Shanghai Chest Hospital Cardiology Department of Cardiac Surgery Professor Guo Zhen", "The Hope of Heart and Lung Failure - Artificial Heart and Lung Technology" live broadcast selection and collation of the article. Good heart and good life, you and I guard together! Combined with full video understanding, the results are even better:
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Get to know ECMO technology concepts and applications
In the past two years, due to the impact of the new crown pneumonia epidemic, ECMO technology (also known as "extra-Corporeal Membrane Oxygenation" technology, full English name "Extra-Corporeal Membrane Oxygenation") has gradually become well-known to the public, in fact, it is an artificial alternative technology for the temporary function of the failed lung and/or the heart failed: by replacing the heart to drive blood flow to play the function of pumping blood, by replacing the lungs for carbon dioxide and oxygen exchange function. In principle, it is divided into two modes: venous-arterial mode and venous-venous mode, as shown in the following figure:
Professor Guo introduced ECMO technology to give patients a window of time to win life opportunities, so that:
The heart and lungs are fully rested;
Waiting for the recovery of heart and lung function;
Gain valuable time for doctors to fight for treatment;
There are two main categories of patients who need ECMO technology clinically, namely heart failure or lung failure, and the specific common diseases are listed in the following figure:
Correctly understand the clinical application value of ECMO technology
Professor Guo reminded everyone that ECMO technology is a means for the transition of the acute period, for which its effect is obvious, and then through 3 cases, let everyone intuitively feel:
Case 1: Explosive myocarditis (see figure below)
This patient underwent ECMO technology assistance at 21:00 p.m. after the onset of rapid ventricular fibrillation and circulatory failure, which can be clearly seen through the picture: 1. The heart contracts strongly; 2. The blood pressure has a significant waveform; and the subsequent patient's cardiac function is almost completely restored.
Case 2: Pulmonary infarction (see figure below)
The patient was first assisted by ECMO technology, then replaced by a portable assist device and successively went to the catheterization room for right cardiac angiography and a clear diagnosis in the CT room for 8 days after successfully recovering and discharging from the hospital.
Case 3 lung transplantation (see figure below)
From the above chest x-ray, we can feel that this patient was fortunate to be transplanted to the donor assisted by ECMO technology, and recovered well within 2 days after the operation, successfully detached from the assist, and gradually started rehabilitation training independently.
Although the above cases have a gratifying ending, Professor Guo said during the live broadcast that the success rate of ECMO technology is a certain proportion. ElSO organization as of December 31, 2019 more than 16,000 patient data analysis showed that only 55% of the successful discharge, of which further analysis can see that the auxiliary effect of newborns, children and adults in different situations is different, such as the success rate of respiratory failure in newborns is very high, while the success rate of resuscitation in patients with cardiac arrest is very low, as shown in the figure below:
In addition to the differentiated results, ECMO technology itself will also bring some complications, which need to be paid attention to, especially by clinicians. In many cases, ECMO can bring surprising outcomes at the same time, but in terms of the cost of patients and their families, it is not unattainable, generally divided into direct and indirect costs (see the figure below)
Which hospitals can carry out ECMO technology applications?
ECMO is relatively cutting-edge and complex technology, and it is generally available in tertiary first-class cardiopulmonary specialized hospitals or general hospitals that are relatively strong in the treatment of cardiopulmonary diseases. It requires multidisciplinary cooperation such as cardiology, pulmonology, and intensive care to be successfully completed, which is also the most basic requirement. The ability of this technology to be carried out is also a reflection of the ability of a hospital or a region to treat critically ill diseases.
The following figures show the ECMO platform and workflow diagram of Shanghai Chest Hospital respectively:
From the above figure, we can also understand that it requires teamwork and cooperation, and it can be carried out more successfully in hospitals with higher professional levels.
Selected netizens ask questions online, and experts explain ECMO technology hotspots in detail
Question 1: After my father did ECMO, the doctor checked for a blood clot during the review, although it was also treated symptomatically, but he still felt unwell, is it a psychological reason?
Professor Guo Zhen: As mentioned earlier, bleeding and thrombosis are one of the most common complications of ECMO. If the patient recovers and is not very serious after discharge, symptomatic treatment can be made, such as the use of anticoagulant drugs and regular re-examination. In addition, it is difficult to visually judge the physical discomfort, and it is recommended to go to the hospital for specific examination and diagnosis.
Question 2: If a pregnant woman has heart and lung failure, can she go to ECMO? Will it affect pregnant women and the fetus?
Professor Guo Zhen: Pregnant women can definitely receive ECMO treatment, which will indeed have an impact on pregnant women and fetuses, but the impact on pregnant women is small, because pregnant women are the main treatment object, and the fetus is the object of protection. On the one hand, more oxygen will be given clinically to avoid fetal hypoxia; on the other hand, the use of drugs that affect fetal growth and development will be minimized in clinical treatment.
Question 3: During the COVID-19 epidemic, several doctors infected with COVID-19 in Hubei have appeared "blackface" after using ECMO.
Professor Guo Zhen: In fact, the darkening of the skin color is not a complication of ECMO, I guess it should be due to his serious condition, lack of oxygen caused by other organs, such as liver function damage caused by skin pigmentation darkening, similar to common jaundice, and other liver function will gradually improve after the recovery of liver function.
Question 4: My grandfather's terminal cancer is already dying, is it still necessary for ECMO to replace cardiopulmonary function to maintain cardiopulmonary function?
Professor Guo Zhen: This is a very good question, and it is also a common problem for ECMO indications and contraindications. Technically, ecmo can be sustained even if the heart and lungs lose function, but we need to assess whether the patient benefits the most. For a patient with advanced cancer, if his survival period is half a year or 1 year, and the current respiratory failure may take his life within 1 week, then the clinic believes that ECMO can be used to assist therapy, but even if it is assisted, the cancer itself will be life-threatening, which is of little significance at this time. This is not a technical consideration, but more of a combination of ethics and comprehensive circumstances.
Good heart and good life, you and I guard together! Professor Guo Zhen brings you a heart-saving golden sentence, inviting you to remember: I hope that with the development and popularization of ECMO technology, it can bring a first-line hope for survival to more and more patients with cardiopulmonary failure!