| 1. Extracorporeal membrane oxygenation(ECMO) for non-surgical cardiac arrest adults Objective: To evaluate the effect of ECMO for non-surgical adult cardiac arrest. Method: We retrospectively analyzed the non-surgical cardiac arrest adults who underwent ECMO therapy between January 2010 and July 2015. Results: Twenty-five patients were enrolled and the mean CCPR duration was 47.4 min and success rate of ECMO resuscitation was 100%. NIne patients(36%) were successfully weaned and seven patients(28%) survived to hospital discharge. Survivor group had a longer CCU stay [(20.0±13.2)d vs(5.5±6.3d)], higher mean blood pressure 24 hours [(91.1±20.4)mm Hg vs(73.2±20.1)mm Hg] and 48 hours after ECMO initiation [(86.6±18.0)mm Hg vs(63.0±16.7)mm Hg],and higher platelet count at 72 h after ECMO establishment [(97.3±31.5)×109/L vs 57.0± 30.1)×109/L](P<0.05). Primary percutaneous coronary intervention was implemented successfully to the subgroup from acute myocardial infarction(AMI)(n=20), survival group of which had a shorter CCPR duration [(29.2±4.9)min vs(51.0± 24.5)min], a higher proportion of right coronary artery(50% vs 7.1%) and lower proportion of left anterior descending branch(16.7% vs 57.1%) in culprit vessel distribution, higher rate of ECMO withdrawal(100% vs 14.3%), higher mean arterial pressure [(87.89±19.38) mm Hg vs(101.73±32.67)mm Hg] and lower level of arterial lactic acid [(1.74±0.85) mmol/L vs(6.41±5.65)mmol/L] at 48 h after ECMO support(P<0.05). Conclusion: ECMO can be used as an effective alternative option for refractory cardiac arrest in non-surgical adults. Low flow time before E-CPR, hemodynamic status within the first 48 hours, platelet count at 72 h and the distribution of culprit vessels of AMI subgroup might have a predictive value for survival to discharge.2. Comparisons between coronary artery bypass grafting(CABG) with ECMO-conventional cardiopulmonary bypass switch and off-pump mode Objective To compare the perioperative characteristics and long-term outcomes in high-risk CABG with ECMO-conventional cardiopulmonary bypass switch andoff-pump mode. Methods Perioperative characteristics and survival rate of both groups were analyzed retrospectively from January 2010 to December 2014. Results 26 and 24 patients were enrolled into the switch mode group and OPCABG group. The average Euroscore value were 11.7±2.4 and 10.9±2, respectively. The switch mode group had a higher complete revascularization rate(66.7% vs 96.2%), better intraoperative fluid balance control[(13.5± 593.5)ml vs [(60.6±615.5)ml], a shorter length of postoperative ECMO support(33.1±23.6)h vs(80.8±18.5))h], intensive care unit stay [(4.8±1.1)d vs(10.2±9.0)d] and hospital stay(17.7±6.3) d vs(28.2±17.5)d](P <0.05). The switch mode group had a significant better survival rate without MACE after hospital discharge than OPCABG group(P=0.028). Conclusion The novel cardiopulmonary byass mode may facilitate a higher complete revascularization, a shoriter postoperative hospitalization and improve the survival rate without MACE in high-risk CABG.3. ECMO Outcomes in Severe Adult Respiratory Distress(ARDS) Treatment Aim: To evaluate the effectiveness and safety of ECMO for severe ARDS patients. Methods: We retrospectively analyzed 23 ARDS patitents with ECMO therapy between January 2009 and July 2015. Several survival predicting models were calculated and validated. Results: Thirteen patients(56.5%) survived to hospital discharge. Compared to the non-survival group, the survival group had lower APACHE II score, lower proportion of acute kidney injury and multiple organ dysfunction(P<0.05). Univariate correlation analysis demonstrated that APACHE II score(r=-0.463, P=0.03), pre-ECMO cardiopulmonary resuscitation(r=-0.435, P =0.043), acute kidney injury(r=-0.574, P=0.005), multiple organ dysfunction(r=-0.633, P=0.002), 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 discharge. The evolution of levels of blood urea nitrogen, platelet, and fibrinogen may help to determine theprognosis. RESP and APACHE Ⅱ scores showed excellent discriminate performance in predicting survival with an area under the curve(AUC) of 0.835(95% CI 0.659 to 1.010, P=0.007) and 0.762(95% CI 0.558 to 0.965, P=0.035), respectively. The optimal cutoff values were risk class 3.5 and 35.5 respectively, both with 70% sensitivity and 84.6% specificity. Plus, the SOFA score was also shown to have a good discriminate performance in the pneumonia subgroup, with an AUC of 0.790(95% CI 0.571 to 1.009, P=0.038). Conclusions: ECMO is an effective alternative for severe ARDS. RESP, APCHAE Ⅱ and SOFA scorings could be good predictive to hospital survival.4. Ultra-performance Liquid Chromatography and Mass Spectrometry(UPLC/MS) for Pathway Analysis in Young ST-Segment Elevation Myocardial Infarction(STEMI) Patients Aim: To establish a differentiation model for STEMI youth patients by UPLC/MS platform, search for the closely related characteristic metabolic pathways. Methods: 47 consecutive STEMI patients(23 youth and 24 aged) and 48 healthy people in control groups(24 youth and 24 aged) were registered prospectively. Characteristic metabolites and relative metabolic pathways were screened via UPLC/MS platform. Results: We successfully established an orthogonal partial least squares discriminated analysis model(R2X=71.2%, R2Y=79.6%, Q2=55.9%), and 24 ions were screened out. Sphingolipid metabolism is the top altered pathway. The ROC curve analysis showed that ceramide and sphinganine have a high sensitivity and specificity on survival without major adverse cardiovascular events after discharge of youth patient. The area under curves was 0.671, 0.750 and 0.711, respectively. The validation one year after morbidity was correspondingly 0.778, 0.833 and 0.806. Conclusions: Sphingolipid metabolism is the top altered pathway in STEMI youth patient, which could hopeful to be a prognostic factor and potential therapeutic target. |
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