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Objective:To study the effect of magnetic nursing concept on improving nurses' nursing ability of extracorporeal membrane oxygenation (ECMO).Methods:In the study, 33 nurses of emergency intensive care unit of The First Affiliated Hospital of Nanjing Medical University from January 2019 to December 2020 were selected as the research objects. From January 2019 to December 2019, the Department carried out routine nursing management, and from January 2020 to December 2020, the Department implemented the management mode of magnetic nursing concept. The mastery of nursing knowledge of ECMO was analyzed by using scale, and the critical thinking ability and self-study ability of the nurses were compared before and after intervention. SPSS 22.0 was used to perform t test on the data. Results:After the intervention, nurses' mastery of respiratory system nursing, circulatory system nursing, fluid balance nursing, skin nursing, digestive system nursing, bleeding, anticoagulant problem nursing, hospital infection prevention and control, and pipeline nursing related knowledge of ECMO patients was significantly better than that before the intervention ( P<0.05). After the intervention, nurses' truth-seeking, open thinking, systematic ability, analytic ability, thinking self-confidence, thirst for knowledge, cognitive maturity and total scale scores were significantly higher than those before the intervention ( P<0.05). After the intervention, nurses' self motivation belief, task analysis, self-monitoring and regulation, self-evaluation and total score were significantly higher than those before the intervention ( P<0.05). Conclusion:The nursing management mode of magnetic nursing concept is of value in improving nurses' autonomous learning ability and critical thinking ability.
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Objective:To analyze the early volume characteristics of patients with severe cardiogenic shock treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and the relationship between their early volume and the prognosis.Methods:This study reviewed patients of Emergency Medical University , treated with VA-ECMO and screened the patients with severe cardiogenic shock and VA-ECMO running more than 72 h for further study. The basic condition of the patients was recorded, and the fluid balance in the first 72 h was analyzed. The patients were grouped according to their fluid balance in the first 72 h. The gender, age, survival rate, continuous renal replacement therapy (CRRT) rate, intra-aortic balloon pump (IABP) rate, and invasive mechanical ventilation rate were compared between the two groups, and the relative risk to the prognosis was calculated. The prognosis was compared between the two groups. Results:Totally 77 patients with severe cardiogenic shock were enrolled. Forty-one cases survived, with an overall survival rate of 53.2%. The volume balance at 48-72 h and the total volume balance at the first 72 h were different between the survival and dead groups. Compared with the positive balance group, patients in the negative balance group were less likely to receive CRRT or invasive mechanical ventilation during the first 72 h. Patients in the negative balance group during the first 72 h had a better survival rate, and their relative risk of survival was 1.81 (95% confidence interval: 1.101, 2.985). However, there was no significant difference in survival rate according to every 24 h fluid balance.Conclusions:Patients with severe cardiogenic shock treated with VA-ECMO who had negative total volume balance during the first 72 h are more likely to survive and less likely to require CRRT or invasive mechanical ventilation.
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Objective:To study the application of blood products in patients with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and evaluate its effect on the prognosis.Methods:A total of 83 adult patients treated with VA-ECMO in the Emergency Department of the First Affiliated Hospital of Nanjing Medical University from January 2017 to January 2020 were grouped by survival to explore the risk factors of 28-day mortality using binary logistic regression, and the threshold was calculated by ROC curve.Results:Platelet transfusion ( OR=2.506, 95% CI: 1.142-5.499) and non-myocarditis disease ( OR=6.881, 95% CI: 1.615-29.316) were the risk factors of 28-day mortality in adult VA-ECMO patients. The threshold of platelet transfusion was 0.427 mL/(kg·d) (sensitivity 78.4%, specificity 69.6% , AUC 0.735). Conclusions:The increased platelet transfusion is related to the poor prognosis of adult patients with VA-ECMO. Refractory myocarditis patients are better treated with VA-ECMO.
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Objective:To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) support in acute myocardial infarction (AMI) complicated by cardiogenic shock.Methods:Thirty-seven AMI patients received ECMO from March 2016 to October 2020 in Emergency Department of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. Gensini score was used to evaluate the coronary lesion severity, vasoactive-inotropic score (VIS) was used to assess the usage of vasoactive-inotropic drugs, and cumulative fluid balance (CFB) was used to calculate the fluid balance status, respectively. According to the infarct-related artery, positive/negative fluid balance, and survival/death outcome, the patients were divided into the negative and positive fluid balance groups, and the survival and death groups, respectively. The relationship between Gensini score, 24-hVIS, CFB and patient outcome was analyzed.Results:Thirty AMI-ECMO patients were enrolled, 12 patients survived and 18 died with a mortality rate of 60.0%, and 80.0% of the infarct-related artery were left main and proximal left anterior descending artery. The Gensini score was 77 (52, 120), 24-h VIS 50.0 (31.1, 80.4), daily fluid volume 28.7 (26.6, 34.4) mL/(kg·d), and CBF -1.8 (-9.7, 8.0) mL/kg. The mortality and 24-h VIS of the negative fluid balance group were significantly lower than those of the positive fluid balance group, and the Gensini score, 24-h VIS and CBF of the survival group were significantly lower than those of the death group.Conclusions:LM and pLAD are the most common infarct-related arteries in AMI-ECMO patients, the Gensini score and 24-h VIS have a certain prognostic value, and early negative fluid balance may improve the survival rate.
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Objective:To evaluate left ventricular systolic function (LVEF) after extracorporeal membrane oxygenation (ECMO) in patients with acute fulminant myocarditis (AFM).Methods:Seven patients were admitted in the First Affiliated Hospital of Nanjing Medical University from August 2018 to November 2018. All the patients accepted veno-arterial extracorporeal membrane oxygenation (V-AECMO). Complications associated with ECMO and clinical outcome were documented. Transthoracic echocardiography (TTE), single photo emission computed tomography (SPECT), and cardiac magnetic resonance (CMR)were performed to evaluate LVEF.Results:Seven patients were successfully weaned from V-AECMO, 2 of whom had oxygenator leakage, 4 had femoral artery bleeding after decannulation, and 2 had femoral artery pesudoaneurysm. There was no statistical difference in LVEF evaluation between TTE and CMR [(62.4±6.8)% vs (58.9±8.2)%, P >0.05]. CMR and SPECT further revealed myocardial pathological change and coronary arterial blood perfusion. Conclusions:ECMO is recommended in patients with AFM. TTE is simple and easy to perform and is not inferior to CMR in LVEF evaluation. CMR can reflect pathological changes of cardiomyocytes at the cellular level, and SPECT can reflect coronary perfusion.
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Objective:To summarize the inter-hospital transport experience on extracorporeal membrane oxygenation (ECMO) led by a team from emergency department.Methods:The clinical data of 21 patients transferred under the support of ECMO between December 2016 and February 2019 were retrospectively analyzed. All patients were transferred to the First Affiliated Hospital of Nanjing Medical University from other hospitals. Interhospital distance, transport methods, patient demorgraphic characteristics, disease diagnosis, intubation location, intubation method, adverse events during transport and transport outcome were retrieved.Results:Eighteen of the 21 patients were transferred under our mobile ECMO team from outer hospitals to our ECMO intensive care unit. Three patients were cannulated by physicians of outer hospital and transported to our ECMO intensive care unit. All patients were transported by ground ambulance, and the distances varied from 2.5 to 252 km, with an average distance of 112.3±103.2 km. No death occurred during transportation. Adverse events in transport occurred in 6 patients. Of these, the most common were patient-related adverse events..Conclusions:Inter-hospital transport by ECMO in China is currently dominated by ground ambulance.. Experienced mobile ECMO team can safely operate inter-hospital transport supported by ECMO
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Objective To determine the predictive values of different critical scoring systems for survival rate after discharge in critically ill patients supported by extracorporeal membrane oxygenation (ECMO). Methods The clinical data of 34 critically ill patients supported by ECMO admitted to Department of Emergency of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People's Hospital) from July 2015 to September 2017 were retrospectively analyzed. The general information and the worst values of vital signs and related pathophysiological indicators within 12 hours before ECMO treatment of patients were collected, and sequential organ failure assessment (SOFA), multiple organs dysfunction score (MODS), simplified acute physiology score Ⅱ (SAPSⅡ), and acute physiology and chronic health evaluation Ⅳ(APACHEⅣ) scores were calculated. The patients were divided into survival group and non-survival group according to 28-day survival after hospital discharge. General clinical characteristics and aforementioned scores were compared between the two groups. Scoring systems for predicting prognosis were assessed by using the receiver operating characteristic (ROC) curve. The Kaplan-Meier method was used to depict the surviving curve. Results Thirty-four patients were finally enrolled, 13 of whom were dead at the follow-up period of 28 days after hospital discharge, and 21 survived. Duration of ECMO support in non-survival group was significantly shorter than that in survival group (hours: 101.4±7.8 vs. 134.4±12.6), SOFA, SAPSⅡ, and APACHEⅣ scores were significantly higher than those of survival group (SOFA score: 10.6±3.6 vs. 8.8±3.3, SAPSⅡscore: 38.7±14.3 vs. 31.8±12.5, APACHEⅣ score: 46.5±15.5 vs. 38.1±11.3, all P < 0.05). There was no significant difference in gender, age, body mass index (BMI), vital signs or related pathophysiological indicators within 12 hours before ECMO treatment, or MODS score between the two groups. ROC curve analysis showed that the area under ROC curve (AUC) of SAPSⅡ score for predicting 28-day survival rate was the highest, which was significantly higher than that of SOFA, MODS, and APACHEⅣ score (0.880 vs. 0.694, 0.654, 0.682, all P < 0.05). When the best cut-off value of SAPSⅡ score was 43, the sensitivity was 81.2%, and the specificity was 77.9%. Kaplan-Meier survival analysis showed that 28-day survival rate after hospital discharge in patients with SAPSⅡ score < 43 (n = 18) was significantly higher than that in patients with SAPSⅡ score ≥43 (n = 16; χ2= 2.444, P = 0.018). Conclusions Four critical scoring systems of SOFA, MODS, SAPSⅡand APACHEⅣ have been proved to have good prognostic ability to predict 28-day survival after hospital discharge in critically ill patients supported by ECMO. Among them, SAPSⅡ score system has more accurate prediction value.