I-ECMO-indlela yokusekela impilo yabantu abagulayo kakhulu-isiye indlela ende
Nakuba sisekude nokuthuthukiswa kohlelo lokusekela impilo emnyama-i-Vaderesque, i-ECMO noma i-membrane okwenziwe nge-extracorporeal oxygenation iye yaba yindlela ende eminyakeni yamuva. Nakuba okokuqala izindlela zokwelashwa ezisetshenziselwa ukusiza izingane ezisanda kuzalwa, inani elikhulayo labantu abadala lithola i-ECMO, futhi izikhungo ze-ECMO ziyavela emhlabeni jikelele.
Ngokusho kwe-Extracorporeal Life Support Organisation (ELSO), eqhubeka nokuqhuba amathebhu ku-ECMO, kusukela ngo-1990, i-ECMO isetshenziselwe ukusiza abantu abangu-58 842 emhlabeni wonke, leyo namba ikhula njalo ngonyaka.
Nakuba cishe isigamu salezi zimo zibandakanya izinkinga zokuphefumula, ama-10,426 amacala ahlanganisa abantu abadala abanezinkinga zokuphefumula nezinhliziyo noma badinga ukuvuselelwa kwamaphalenda.
Kuyini i-ECMO?
I-ECMO (i-AKA yokusekela impilo noma i-ECLS) yindlela emfushane yokuhlinzeka ngempilo kubantu abagulayo kakhulu (cabanga ngamaphaphu noma ukuhluleka kwenhliziyo). Ngokuqondile, i-ECMO igxilisa oksijeni egazini futhi isusa i-carbon dioxide. Kungasiza futhi ukuhlinzeka nge-hemodynamic (ukucindezelwa kwegazi). I-ECMO iyindlela yokusebenzisa i-cardiopulmonary bypass futhi isetshenziswa ngaphandle kwekamelo lokusebenza. Imishini ye-cardiopulmonary bypass (imishini ye-heart-lung) isetshenziselwa amahora ambalwa ngesikhathi sokuhlinzwa.
I-ECMO ivame ukusetshenziselwa ukuthatha ukucindezeleka emaphashini nasenhliziyweni izinsuku ezimbalwa, okuyinto ekhuthaza ukuphilisa. Isetshenziselwa iziguli lapho, uma ziphuthunyiswa ngokushesha, amathuba abo okusinda zihle, futhi ngubani ozofa ngaphandle kwe-ECMO.
Kusukela ngo-1944, abacwaningi baqaphela ukuthi igazi elidlula izibilini ezingenakulinganiswa laba yi-oxygenated. Lokhu kubhekwa kwaba yisisekelo se-cardiopulmonary bypass. Ekuqaleni, i-bypass ye-cardiopulmonary ixhomeke ku-bubble noma i-disk oxygenators eveze igazi ngqo emoyeni. Umphumela omubi walolu hlobo lwangaphambili lwe-bypass lwathinteka i-hemolysis noma ukubhujiswa kwamangqamuzana egazi okwehlisa inzuzo yawo emahoreni ambalwa kakhulu.
Ngo-1956, ukuthuthukiswa kwe-membrane oxygenator kwalungisa le nkinga futhi kwasekelwa isisekelo sokusebenzisa isikhathi eside kwe-ECMO.
Nazi izingxenye ze-ECMO ejwayelekile:
- ukushisa umthengisi
- i-membrane oxygenator
- ipompi le-roller noma i-centrifugal
- amashubhu wesifunda
- ama-catheters aqondene nesayithi lokufinyelela (i-VV ECMO ibuyisa igazi kwisistimu ye- venous nge-vena cava ephakeme noma i-atrium elungile, futhi i-VA ECMO iphinda ibuyele igazi ohlelweni lwe- arterial nge-aorta noma i-carotid artery)
Kwamanye ama-set ups, isifunda esifanayo equkethe enye ipompo ne-oxygenator esetshenziselwa ukusiza nge-oxygenation nokukhishwa kwe-carbon-dioxide. Amazinga okugeleza ahlelwe ngokususelwa kokuqapha okusheshayo kwe-homeostasis yesiguli: ukucindezelwa kwegazi, isimo se-asidi-base, umsebenzi wokuphela komzimba, kanye nesimo sezinyosi ezixubile. Inothi, i-VA ECMO kuphela ihlinzeka nge-hemodynamic noma nge-blood pressure support. Okokugcina, nakuba i-bypass egcwele i-cardiopulmonary igxilile ekamelweni lokusebenza ngaphansi kwe-anesthesia ejwayelekile, i-ECMO ijwayele ukusebenzisa i-anesthesia yendawo.
Iziguli ezise-ECMO ngokuvamile zigula kakhulu, futhi akuwona wonke umuntu osinda kulokhu okuhlangenwe nakho. Ngo-2013, i-ELSO ibike ukuthi emhlabeni wonke abantu abangamaphesenti angu-72 kuphela abasinda ku-ECMO nalezi zibalo ezilinganiselwe kakhulu kubantu abaye banciphisa ukulimala kwamapayipi.
(Khumbula ukuthi ingane inamapayipi amasha futhi ngaleyo ndlela ivame ukufaka i-ECMO ngaphandle kokulimala komonakalo noma okuhambisana nomaphaphu okwenzekayo kubantu abadala.) Ngaphezu kwalokho, nakuba amaphesenti angu-72 kubo bonke abantu asinda ku-ECMO, amaphesenti angu-60 kuphela akwenza ukuba akhiphe noma aphinde abuyele-lesi sibalo wayelinganiswa ngokusondelana nezinsana. Ngokuqondile, amaphesenti angu-56 kuphela abantu abadala abanezinkinga zokuphefumula okwenze ukuba kukhishwe noma kudluliselwe.
Imiphumela emibi ye-ECMO ihlanganisa ukuphuma kwamanzi kwangaphakathi nangaphandle, ukutheleleka, i-thrombosis (izingxube zegazi ezisongela ngaphakathi kwemithambo yegazi) nokuphambaniswa kwepompo. Ukuze kunciphise usongo lwe-thrombosis, izingxenye ze-ECMO ziboshwe i-heparin, igazi elincane.
Ngabe i-ECMO isebenze nini?
Nazi ezinye izimo lapho i-ECMO isetshenziselwa izinsana:
- ukuphikelela komfutho wegazi we-pulmonary okuqhubekayo (PPHN)
- i-neonatal meconium aspiration syndrome
- I-pneumonia noma ezinye izifo ezinzima
- umlando wakhe wesifo esiyingqayizivele
- isifo senhliziyo esiswini
Nazi ezinye izimo lapho i-ECMO isetshenziselwa izingane ezindala:
- ukulungiswa kwenhliziyo okulandelayo
- i-aspiration pneumonia
- i-pneumonia
- i-sepsis
- ubuthi
- eduze-ekomile
- i-asthma enzima
- ubuthi
Ukusetshenziswa kwe-ECMO kuyindlela yokuthola imithi yabantu abadala. Nakuba kunobuthakathaka bobufakazi obusekela ukusetshenziswa kwayo yonke indawo (okungukuthi sidinga ukuhlolwa okukhulu okungahleliwe ukuze kufike iziqondiso zomhlaba wonke), imibiko yesikhala, izifundo zokubuyela emuva nokunye okuvelayo okuphakamisa ukuthi i-ECMO ingaba usizo ezinhlobonhlobo ezahlukene izimo. Inothi, nakuba kungekho ukuphikisana okuphelele kokusetshenziswa kwayo, ukuphikisana okuhlobene, okuyingxenye ngokusekelwe kumbono wochwepheshe, kuye kwaphakanyiswa ukuthi kufaka phakathi isimiso somzimba sokukhubazeka (ukukhulelwa komzimba), ingozi enkulu yokugaya igazi (i-coagulopathy ephawuliwe), ubudala obudala kanye ne-BMI ephezulu.
Nazi ezinye izimo lapho i-ECMO isetshenziswa kubantu abadala:
- ukubopha inhliziyo ukubophezela ukushayeka kwe-myocardial infarction noma embolism ye-pulmonary
- ukuhluleka kwenhliziyo
- ukuhluleka ukuphefumula kuya kwesifo esibuhlungu sokucindezeleka (ARDS) noma i-H1N1 virus
Ezinye izingxenye ezimbili ngolwazi ku-ECMO njengoba likhuluma ngabantu abadala. Okokuqala, ngokungafani nama-ventilators, i-ECMO igwema ukulimaza amaphaphu ngokudabuka (i-barotrauma) noma i-atelectasis (ukuwa kwephunga). Okwesibili, ukuhlaziywa kwe-meta (ucwaningo oluhlanganisiwe) lubonisa ukuthi i-ECMO ingaba nenzuzo elinganiselwe kulabo abathola ukuguquka kwenhliziyo, labo abane-viral cardiomyopathy (ukutheleleka kwesifo senhliziyo) nalabo abane-arrhythmias abahlulekile ukuphendula ukwelashwa okuvamile.
Ngombhalo wokugcina, i-ECMO cishe iyindlela yokwelashwa ongasoze uhlangana nayo noma ngabe impilo yakho noma izimpilo zabathandekayo bakho abanenhlanhla; I-ECMO inkulu futhi igcinwe kulabo abagula kakhulu. Noma kunjalo, i-ECMO imelela indlela entsha ethenjisayo yokusiza abantu abaningi. Nakuba singalokothi sihlakulele uhlelo lokusekela impilo oluphindaphindiwe njengesigqoko sokuzivikela sikaDarth Vader, senza ngcono ukuqonda kwethu ngokusekelwa kwempilo yesikhathi esifushane esasimisiwe.
Imithombo
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