收稿日期: 2025-06-30
录用日期: 2025-12-19
网络出版日期: 2026-01-30
Application of VA-ECMO in high-risk percutaneous coronary interventions under different clinical conditions
Received date: 2025-06-30
Accepted date: 2025-12-19
Online published: 2026-01-30
虽然冠状动脉旁路移植术（coronary artery bypass grafting，CABG）是大部分复杂冠脉病变患者的首选治疗方法，但在某些病例，尤其是急危重症、血流动力学不稳定的情况下，机械循环支持（mechanical circulatory support，MCS）下的经皮冠状动脉介入治疗（percutaneous coronary interventions，PCI）可能是不劣于CABG，甚至更优的方案。目前，基于现实世界的观察结果，主动脉内球囊反搏（intra-aortic balloon pump，IABP）这一临床上最常用的循环辅助方式在指南中的推荐地位已经逐步降低。受限于实际硬件条件，Impella在我国尚未推广使用。静脉-动脉体外膜肺氧合（veno-arterial extracorporeal membrane oxygenation，VA-ECMO）得益于其全面而强有力的心肺替代功能，近几年来在我国的应用逐渐普及。该文主要总结不同临床背景下关于VA-ECMO在高危PCI（high-risk PCI，HR-PCI）中应用的研究，为临床工作提供参考和借鉴。
关键词： 静脉-动脉体外膜肺氧合; 经皮冠状动脉介入治疗; 体外心肺复苏; 心源性休克
邓钰莹 , 黄修献 , 王圣 . 不同临床状况下VA-ECMO在高危经皮冠状动脉介入治疗中的应用进展[J]. 上海交通大学学报（医学版）, 2026 , 46(1) : 123 -131 . DOI: 10.3969/j.issn.1674-8115.2026.01.015
Although coronary artery bypass grafting (CABG) remains the preferred treatment for most patients with complex coronary artery lesions, percutaneous coronary intervention (PCI) supported by mechanical circulatory support (MCS) may be a non-inferior or even superior alternative in specific cases, particularly in critically ill patients with hemodynamic instability. Recent real-world evidence has led to a downgrade in guideline recommendations for the intra-aortic balloon pump (IABP), which has been the most commonly used circulatory assist device in clinical practice. Due to limited availability, the Impella device has not yet been widely adopted in China. In contrast, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), owing to its comprehensive and robust cardiopulmonary replacement capabilities, has seen an increase in utilization across China in recent years. This article reviews current evidence on the application of VA-ECMO in high-risk PCI (HR-PCI) under various clinical conditions, aiming to provide valuable references for clinical practice.
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