2．PCPS挿入法

How to Place Percutaneous Cardiopulmonary Support （PCPS）

まず用語の確認であるが，経皮的心肺補助（PCPS）という用語は日本と一部の国でしか使用されておらず，国際的には経皮的静脈脱血-動脈送血体外式膜型人工肺（VA-ECMO）と呼ばれる．日本で体外式膜型人工肺（ECMO）というと呼吸補助を目的とした静脈脱血-静脈送血のECMO（VV-ECMO）を示すことが多いが，補助循環状態を正確に示す意味からもPCPSより経皮的VA-ECMOという用語が適切である1）．

Cannulation for percutaneous cardiopulmonary support （PCPS） is usually performed percutaneously. However, cut down exposure of the vessels is needed if percutaneous cannulation is difficult. Once the vessels are exposed, cannulas can be placed either by a direct cut down cannulation or by a Seldinger technique. Vascular access is usually achieved through femoral vessels, but other large vessels can be used in specific patient conditions. For instance, neck vessels are commonly used for veno-venous extracorporeal membrane oxygenation （ECMO）. In patients who cannot come off cardiopulmonary bypass, direct cannulation of the aorta and right atrium （central ECMO） is a simple way. Complications related to cannulation are bleeding, vascular injury, arterial embolism, and distal malperfusion. Thoracic surgeons must have up-to-date information and become proficient in these procedures.