國立臺灣大學醫學院外科柯文哲Ko, Wen-JeWen-JeKo2006-07-262018-07-112006-07-262018-07-112003-07-31http://ntur.lib.ntu.edu.tw//handle/246246/24498Objective: The outcome of extracorporeal membrane oxygenation (ECMO) treatment is always unpredictable when it is not indicated for neonatal respiratory diseases. A prospective study was conducted to collect clinical, biochemical, immunological parameters at variable times during an ECMO course to determine which factors influenced ECMO outcome. Methods: The patients’ demography, pre-ECMO conditions, biochemistry, hematology, and arterial blood gas analysis during ECMO treatment, were recorded along with the duration, outcome and complications of the treatment. Blood was collected on the 3rd and 6th days after initiation of ECMO for cytokines study. Results: Fifty patients who were receiving ECMO for acute cardio/pulmonary failure were studied; 32 were male, and 18 were female. Their ages ranged from 20 days to 84 years; their body weights ranged from 2.4 kg to 95 kg. ECMO was set up in operation rooms (n=20), intensive care units (n=18), cardiac catheterization rooms (n=3), emergency rooms (n=3), and outside hospitals (n=6). The indications of ECMO treatment included postcardiotomy cardiogenic shock (n=27), acute myocarditis (n=5), myocardial infarction that required resuscitation (n=7), cardiomyopathy with cardiogenic shock (n=2), acute respiratory distress syndrome (n=5), and others (n=4). Eleven patients died within 48 hours following initiation of ECMO. The etiologies of mortality included extremely poor heart function (n=5), severe shock damage (n=5), and uncontrollable bleeding (n=1). Three patients died of brain death due to ECMO mechanical failure (n=1) or intracranial hemorrhage while on the ECMO (n=2). Sixteen patients underwent a successful ECMO treatment, but three of them died suddenly months later. Only 2 of 16 successful ECMO patients needed ECMO support for more than five days. The ECMO treatment of 20 patients failed and the patients died of multiple organs failure whether or not they were weaned off ECMO. Comparing instances of successful ECMO with those of failed ECMO by multiple logistic regression, revealed that three independent factors, acute renal failure at the time of ECMO set-up, sepsis during ECMO, lower IL-12 serum level on the 3rd day, predicted a failed ECMO treatment. Conclusion: ECMO is an ideal rescue treatment for acute cardio/pulmonary failure, but a successful ECMO treatment requires the following: 1. Acute cardiopulmonary failure treated by ECMO must be rapidly reversible. ECMO is not intended for prolonged treatment. 2. No severe shock damage must have occurred due to underlying diseases before ECMO support is begun. 3. No complications can occur during ECMO.application/pdf93372 bytesapplication/pdfzh-TW國立臺灣大學醫學院外科extracorporeal membrane oxygenationprognosisacute renal failuresepsiscytokinesinterleukin-12reporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/24498/1/912314B002239.pdf