Is ECMO a life-saving straw for patients? Doctor: It's just in-body life support technology

Medicine Network January 27th, down jacket inside is a "brush hand clothing", emergency doctor Cui Xiaolei recently always wear this way, in order to enter the working state at any time.
critically ill patient with neo-corona pneumonia is changing at any time, leaving little time for the doctor to respond.
In Shijiazhuang, the patients in front of him have an exclusive medical team, the illness is reported six times a day, the doctor's orders by the National Health And Wellness Commission and local expert groups jointly developed, including the use of ECMO - in-body membrane pulmonary oxygenation, a temporary replacement of the heart and lung outside the human body, often regarded as a "life-saving straw" technology.
in early 2021, Shijiazhuang outbreak of a new coronary pneumonia outbreak.
Hebei Medical University Second Hospital organized a medical team to enter the Hebei Chest Hospital, which is designated to treat patients with neo-crown pneumonia, and Cui Xiaolei served as the head of the ECMO team responsible for the treatment of critically ill patients.
as of January 23, they had accumulated 4 cases of ECMO on the market.
January 23rd, the first anniversary of Wuhan's "closed city", Zhou Chenliang, director of the Department of Intensive Medicine at Wuhan University People's Hospital, sent a screenshot in a circle of WeChat friends.
a year ago, he and a colleague were pictured in the intensive care unit with the text, "We'll keep our positions."
Zhou Chenliang was involved in the treatment of the world's first lung transplant patient with new coronary pneumonia, and ECMO gained time for the operation.
year, he has seen some critically ill ECMO "on the plane" after the cure, but also inevitably there will be moments of regret powerless.
" scientists should have such an awareness: all means of treatment and treatment process, need to be constantly reflected, summarized and abandoned.
" Zhou Chenliang said, "Don't let ordinary people think that ECMO technology is the life-saving straw that holds all hope, it is just an in-body life support technology."
most important thing is to see if the original disease is reversible even if wearing protective clothing, Cui Xiaolei still clearly heard, blood oxygen saturation monitor began to alarm.
he looked up, and the blue numbers flashing on the screen quickly decreased.
hospital bed is a critically ill patient with neo-coronary pneumonia, after many days on the ECMO, medical staff to replace supplies for the equipment, including pump head and membrane lung.
This is a "shutdown" operation, during which the instrument can not be like the normal state, the blood from the patient's body, after oxygenation by an artificial oxygenator, and then back into the human body, to support the patient's respiratory system.
the shorter the operation time, the less impact it will have on the patient.
although familiar with the process, Cui Xiaolei and the team members rehearsed several times in advance, "who cuts the pipe, who looks at the machine", to ensure that "nothing is lost."
before the new crown pneumonia pandemic, ECMO did not have the level of awareness it does today.
the Wuhan outbreak, it was once thought to be able to "come back from the dead".
2018, 260 hospitals in China reported 3,923 CASES of ECMO technology applications, according to a paper published in June 2019 in the Journal of the Chinese Medical Association.
different medical institutions, patient survival rate was the highest 51.1% and the lowest 43.5%.
2020, medical institutions across the country are scrambling to apply ECMO as it is successfully applied to critical treatment of neo-crown pneumonia.
Cui Xiaolei is well aware of ECMO's history, starting with the prototype of the technology in the 1950s, talking about "a machine the size of a gasoline barrel" in the 1970s, about ECMO's handling of the SARS outbreak in China in the early 2000s, and the resulting reduced mortality rate.
In his view, the technology can save people, but also "high trauma, high consumption, high complications" problem, whether it can be used, should not be used, how to manage after the use, not only to test the professional standards of the medical team, but also a "social problem."
current ECMO technology has two main applications, in simple terms, VV-ECMO instead of lung function, VA-ECMO instead of cardiopulmonary function.
itself cannot be "cured".
To the new crown pneumonia as an example, when the virus makes the patient's lungs lose function, can not give oxygen to red blood cells, you can apply ECMO technology, the patient's intravenous blood extraction, oxygenation in the in vitro instrument, and then back into the body, but "pneumonia" will not be cured;
"it is only a means of support to buy time for the treatment of the original disease.
" Cui Xiaolei said that while it sustains a patient's life, doctors can treat the disease, "some diseases can be cured, but require the patient's life support sufficient time."
according to him, according to the guidelines and expert consensus issued by the International Organization for Introphy Life Support (ELSO), ECMO's adaptation is mainly caused by a variety of causes of heart-induced shock, including acute myocardial infarction, outbreak of myocarditis, cardiomyopathy, ectrophic surgery and heart transplantation, as well as respiratory failure caused by various causes, such as severe pneumonia, drowning and so on.
, but not the first step in the assessment of ECMO, "the most important thing is to see if the original onset is reversible."
, that is, whether there is any possibility of a cure for the patient's primary illness during ECMO's life-sustaining period.
's not possible, it doesn't make sense to get on the plane.
a consensus issued in December 2020 by the Chinese Society of Cardiovascular anesthesiology, malignant tumors, irrespolitic brain damage, and severe irreversible multi-organ damage are "absolutely taboos" of ECMO technology.
January 2020, the National Health and Wellness Commission issued a guiding diagnosis and treatment program in response to the outbreak of new crown pneumonia in Wuhan.
has been updated to version 8.
The content of refining the timing of ECMO start-up, oxygen saturation, breathing frequency, arterial blood acidity, combined cardiac shock, and cardiac arrest in the case of ventilators are all factors that doctors should consider under the "Treatment of Heavy, Critical Heavy Cases" entry.
also states that "critically serious patients who meet ECMO's designations and have no contraindications should be enabled as soon as possible."
" ventilator used to the extreme, invalid, before considering ECMO.
Zhou Chenliang, who has worked in the intensive care department for many years, explains, "but from the 8th edition of the program, the threshold for applying this technology is not high."
"2020 Wuhan anti-epidemic period, the government to implement free treatment of patients with neo-crown pneumonia."
in a sense, the policy removes another threshold for ECMO to be used in critical cases of neo-crown pneumonia.
in the field of severe medicine: "ECMO sound, gold two thousand."
" in addition to expensive instruments and consumables, ECMO last time, the need for a professional medical team to manage the entire process.
"start 670,000 yuan, change supplies 450,000 yuan, the average cost of one or two thousand yuan a day" is the "average price."
in the daily hospital emergency department and intensive care unit, the cost is not affordable for every "compliant" patient.
January, Cui Xiaolei's team successfully replaced supplies for patients, and the old catheters were cut off and replaced with new catheters pre-flushed with saline.
reboulation, Cui Xiaolei saw blackened vein blood pour into the bright catheter, in the instrument and sufficient oxygen meet, rotate, combine, become bright red, and then through the catheter back into the patient's body.
the oxygen saturation monitor's alarm stopped.
can't completely avoid the problems that ECMO may cause before you get on the plane, you have to think about how to get off the plane.
" Zhou Chenliang said, the application of ECMO technology, testing the comprehensive ability of treatment institutions, the most critical is whether the technical team is adequate staff, experience is rich, "after the machine management is very complex."
can not meet the management conditions, did not consider how to get off the machine, can not hard scalp on the machine.
, he recalls, a year ago, Wuhan University People's Hospital used ECMO for critically ill patients with neo-crown pneumonia because "experts are gathered, the hospital is comprehensively strong, and there is a strong transplant center."
However, Zhou Chenliang also admitted that even experienced doctors can not completely avoid ECMO may cause problems, such as bleeding, hemolysis, infection, kidney failure, blood clots, end limb isoemia, vascular damage, arterial stenosis and so on.
some complications can be life-threatening in the short term, and some can have long-term effects.
noon on January 10, Cui Xiaolei just finished checking the room received a phone call, need him to rush to the hospital immediately, to take over a rapidly deteriorating patient.
When he walked into the intensive care unit with the newly formed ECMO support team, he saw at a glance that the patient's left leg was blackened, a typical feature of VA-ECMO's ischemic end limb, and needed to pierce a "far-end perfusion tube" immediately to restore blood flow to his legs.
don't do it, this leg may not hold up.
," he recalls, patients have taken a lot of blood pressure-boosting drugs and blood vessels are contracting badly.
team was wearing protective clothing and three layers of gloves, and intitation was extremely difficult.
all to be done with the aid of visual ultrasound instruments, they have to seize the time, in front of the protective screen in front of the fog, and strive for a one-time vascular puncture success.
week morning also experienced such a moment.
year ago, when he was replacing a line for a patient who was bleeding heavily, his oxygen saturation continued to decline.
the screen covered in fog, he pressed the puncture port after the patient pulled the tube with gauze, while groping with his hand to complete the puncture tube from another puncture point.
it was the first time he had completed an ECMO tube change operation.
, a large part of the ECMO application in Hebei province has been in the second hospital of Hebei Medical University, where he worked for the past two years.
2020, 97 ECMO treatments were conducted in Hebei province, 38 of which were in his emergency department.
wuhan last year, he was driving back to his hometown of Yantai, "Hebei has very few seriously ill patients, I do not feel the outbreak is very close."
" 10 days later, he was sent to Tangshan, Zhangzhou support, stayed for more than 70 days.
he remembers that there was a local team that mastered ECMO technology, but when he heard the leader say "100 percent to keep the patient alive", he was "a little unsemothed" about the operation.
Xiaolei is not afraid.
received ECMO technical training in Beijing in 2016 and has since been sent to the site of the explosion, H7N9 avian influenza epidemic area and so on.
In this round of Hebei outbreak, as of January 24, 2021, Hebei Medical University Hospital has more than 80 people assigned to the thoracic hospital's medical team, in addition to the department of intensive care, there are emergency, cardiovascular, endocrine, obstetrics and gynecology, neurology and other department members.
Shijiazhuang People's Hospital, which is also a designated treatment hospital, was also taken over by a team of more than 60 people from Sichuan Province.
According to reports, five of the famous "severe eight immortals" in the Wuhan outbreak arrived in Shijiazhuang as members of the National Health and Wellness Commission expert group, including Du Bin, director of internal medicine at the Beijing Concord Hospital of the Chinese Academy of Medical Sciences, Tong Chaoxuan, director of the Intensive Medicine Department at Chaoyang Hospital in Beijing, and Kang Yan, director of the Intensive Medicine Department at Huaxi Hospital of Sichuan University.
Said cui Xiaolei, in the chest hospital, every morning, the national expert group will open a medical seminar, the afternoon is a national "remote online meeting."
Du Bin, Tong Zhaoxuan every day to check the room, the hospital for the new crown pneumonia serious, critically ill patients to implement the "one person, one team" "one person, one program" treatment strategy.
can be transferred at any time, experts can be present at any time.
ECMO team shift every 4 hours, the shift in the expert group to update the latest status of patients, the disease discussion at any time, decision-making.
also responsible for 3 ECMO on-the-plane patients, Cui Xiaolei felt a lot of pressure, but relying on such a medical team, he has a "bottom gas."
In the seriously ill area, Cui Xiaolei saw a lot of "friends who fought side by side last year", in fact, according to his observation, even the hospital medical staff who have never cooperated, there are no obstacles to communication, "our goal is too consistent."
's only hope is to save people with severe new coronary pneumonia, most of them have symptoms of respiratory distress.
in clinical practice, doctors often ask patients to adjust to a "pitch" to improve "breathing."
, however, after the ECMO switch to the pitch, the patient's mouth has trachea intage, dental pads, medical staff to be careful, but also difficult to prevent these devices from touching the patient's tongue and oral mucosa, resulting in bleeding.
problem is that ECMO usually needs to use anticoagulants to make sure the blood is clear and that it is difficult to stop bleeding if the patient is injured.
, for example, new coronary pneumonia can cause patients to develop stressed peptic ulcers, while anticoagulant drugs can cause these ulcers to bleed.
Cui Xiaolei can't forget the "horrifying" scenes.
the patient lost consciousness, put various catheters in his body, in a long state of sedation, experienced a series of disasters, including bleeding.
doctor wrote online, "When I attended ECMO training, the teacher on the podium said, "If I'm going to die, please don't give me ECMO and let me die decently."
, some people have questioned the current ECMO in the new crown pneumonia critical treatment widely used, "is it really necessary?" ""Is it for the statistics to look good, first with technology to continue life, the patient nucleic acid turned negative and then off the machine, and then died, do not have to count the number of deaths of new crown pneumonia?" "I don't see a case like this at the moment.
," Cui Xiaolei said.
," Zhou Chenliang responded, "It's absolutely right to use this technology."
to him, it is indeed a "political task" to simply consider medical behaviour.
we are going to use the strength of the state to spare no effort to reduce the mortality rate and achieve "life first".
" is also right in terms of results, this (saving lives) is a 'big right and wrong' problem, right is right, wrong is wrong.
" according to Zhou Chenliang, whether in China or abroad, ECMO on the aircraft is very strict requirements, including the age limit, "Europe and the United States under 60 years old talent, China's standards raised to 75 years old."
had the experience of dealing with the new crown pneumonia outbreak last year, Rivers