静脉体外膜氧合过程中追加引流后的效果:单中心回顾性研究。

IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-17 DOI:10.1177/02676591241249609
Sagar B Dave, Eric Leiendecker, Christina Creel-Bulos, Casey Frost Miller, David W Boorman, Jeffrey Javidfar, Tamer Attia, Mani Daneshmand, Craig S Jabaley, Mark Caridi-Schieble
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引用次数: 0

摘要

在静脉-静脉(V-V)体外膜氧合(ECMO)过程中,难治性低氧血症可能需要额外的插管(VV-V ECMO)来改善氧合。这种干预包括再循环风险和其他各种不良事件(AE),如肺部损伤、插管位置不当、出血、需要干预的回路或插管血栓(即血栓)或脑损伤。在研究期间,142 名 V-V ECMO 患者中有 23 人转为 VV-V,使用两个独立插管进行双腔引流,并另外放置一个上肢插管用于回流。其中,21 人患有 COVID-19。在转换后的头 24 小时,ECMO 流速更高(5.96 对 5.24 升/分钟,p = .002),但泵速没有显著变化(3764 对 3630 转/分钟 [RPMs],p = .42)。动脉氧合(PaO2)增加(87 vs 64 mmHg,p < .0001),吸氧前静脉饱和度相当(61 vs 53.3,p = .12)。到第 5 天,流量与转换前的值相似,泵速较低,但 PaO2 有所提高。与单纯 V-V ECMO 相比,转为 VV-V ECMO 的患者未经调整的存活率相似(70% [16/23] vs 66.4% [79/119],p = .77)。在混合效应回归模型中,任何 AE 的发生率在最初 48 小时内对 PaO2 有负面影响,但在第 5 天则没有。随着流量的增加,VV-V ECMO 可改善氧合情况,而 AEs 或泵速无显著差异。AE 短暂影响氧合。VV-V ECMO 是治疗 VV-ECMO 难治性低氧血症的有效、可行的策略,可提高流速,但泵速不变。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcomes following additional drainage during veno-venous extracorporeal membrane oxygenation: A single-center retrospective study.

Refractory hypoxemia during veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) may require an additional cannula (VV-V ECMO) to improve oxygenation. This intervention includes risk of recirculation and other various adverse events (AEs) such as injury to the lung, cannula malpositioning, bleeding, circuit or cannula thrombosis requiring intervention (i.e., clot), or cerebral injury. During the study period, 23 of 142 V-V ECMO patients were converted to VV-V utilizing two separate cannulas for bi-caval drainage with an additional upper extremity cannula placed for return. Of those, 21 had COVID-19. In the first 24 h after conversion, ECMO flow rates were higher (5.96 vs 5.24 L/min, p = .002) with no significant change in pump speed (3764 vs 3630 revolutions per minute [RPMs], p = .42). Arterial oxygenation (PaO2) increased (87 vs 64 mmHg, p < .0001) with comparable pre-oxygenator venous saturation (61 vs 53.3, p = .12). By day 5, flows were similar to pre-conversion values at lower pump speed but with improved PaO2. Unadjusted survival was similar in those converted to VV-V ECMO compared to V-V ECMO alone (70% [16/23] vs 66.4% [79/119], p = .77). In a mixed effect regression model, any incidence of AEs, demonstrated a negative impact on PaO2 in the first 48 h but not at day 5. VV-V ECMO improved oxygenation with increasing flows without a significant difference in AEs or pump speed. AEs transiently impacted oxygenation. VV-V ECMO is effective and feasible strategy for refractory hypoxemia on VV-ECMO allowing for higher flow rate and unchanged pump speed.

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来源期刊
Perfusion-Uk
Perfusion-Uk 医学-外周血管病
CiteScore
3.00
自引率
8.30%
发文量
203
审稿时长
6-12 weeks
期刊介绍: Perfusion is an ISI-ranked, peer-reviewed scholarly journal, which provides current information on all aspects of perfusion, oxygenation and biocompatibility and their use in modern cardiac surgery. The journal is at the forefront of international research and development and presents an appropriately multidisciplinary approach to perfusion science.
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