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ECMO历史和展望Dr.RobertBartlettDr.LONGCunExtracorporealLifeSupport(ECLSECMO)Supportofheartorlungfunctionwithmechanicaldeviceswhich:istemporary(daystoweeks),canbepartialortotal,avoidsongoingiatrogenicinjury,andsustainslifewhilebridgingtoorganrecoveryorreplacement.1950s:Flatsheetmembraneoygenators;labdevelopment1971firstsuccessfulcase1972firstpedscardiaccase1975-9ARDStrial9ctrs10%survival1975firstNeonatalcase198618ctrs,500cases1990Standardpracticeforneonatesandpeds2000Standardpracticeforadultsinsomecenters2001-7UKclinicalPRCsinneonatesandadultsEventsinthehistoryofECLSFirstECCinWorldin19531965Lab4daysECCysSantaBarbara,Ca,1971.JDonaldHillMDandMauryBramsonBMEFistsuccessfulECLSPatient1972FirstcardiaccaseEsperanza.ThefirstneonatalECMOsurvivor1975ZapolWM,SniderMT,HillJd,et.JAMA1979;242:2193-2196SignificantStudyandResultDr.RobertBartlettHardandRightCourseSignificantStudyandResult•Lancet2009;374:1351–63SignificantStudyandResultBartlett为什么能成功？1.毅力2.天才3.机会4.其它15ECLSTechniquesELSOCenters20132013ELSO30ImplantableLungAmbulatoryAssistLungWhatisavailableforECMOProtocolforARDSECMOforH1N1ARDSCanwedothebetterinECMO?ECMOBibleELSOGuidelinesWebPage45childreninMelbourne,AustraliaMaximumvasopressors,18arrested47%survivedtoD/CVeryhighflowwithcentralcannulation,73%survived62/24/14%hadno,mild,moderatedisability(MacLaren,PedCCM,2013)ECMOforSepsisShock18CPRpatientsmetprotocolcriteriaforECPR7notresuscitated,3improvedwithCPR(17%)8resuscitatedonECLStocathlab,ICU5discharged,neurointact(61%)ResuscitatedonECLSECMOandVADKaramlou,AnnThoracSurg201245SituationofECMOinChinaEmergeofECCinChinain1958Professorswerecriticizedanddenouncedatpublicmeetings“Culturalrevolution”:ANationalNightmareTechnologyEconomicalWhydidChinesenotdoECMO？during1983-2000FirstECMOcaseinChinain2001SetuptheFirstECMODepartmentin2006AllECMOcases(23)forMyocarditissurvivedsince2002RenmingHospitalofZhongshan，GuangdongChineseLearnfromworld2000----Now中国ELSORes18%Cardiac74%CPR8%Res67%Cardiac26%CPR7%病种分类中国ELSO年龄分类Neonate2%Pediatric19%Adult79%Neonate60%Pediatric26%Adult14%201020122010两年中国ECMO的变化2013年全国ECMO数量排名（医院）2013年全国ECMO数量排名（地区）ELSO（14096/2012）SurvivedtoDC39-49%FuwaiHospital217/2004-2013SurvivedtoDC60%ECMOOutcomeinFuwaiHospital生存率80%4死亡20ECMO225有ECMO,院内死亡率3%无ECMO,院内死亡率11%2010年阜外医院心脏移植和ECMOELSO110例生存率34-46%阜外ECMO成功的主要原因是什么？1.技术高2.设备好3.人员强4.团队棒RegistrySeminarStandardTeamSocialSystemECMOTriumphKeyinChinaGoodResultsDoctorICUCPBNurseTeamWorkLungHeartBrainRecoveryStandardSeminarRegistry63%41%160028.3%Res.ICU2CardiacICU66PolicyInsuranceTransportationEthicsSocialSystemAP-ELSO2013Beijing您们开展ECMO最大的困难是什么？1.领导不支持2.同事不给力3.设备缺乏4.知识不足5576东方和西方的长城一ThanksCallme:13701170565