Intensive Care Unit, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
Surg Today. 2010 Mar;40(3):216-22. doi: 10.1007/s00595-008-4040-z. Epub 2010 Feb 24.
This study compared the respiratory status before and during extracorporeal membrane oxygenation (ECMO) in patients receiving venovenous (VV) and venoarterial (VA) ECMO to evaluate the choice of ECMO in patients with respiratory failure.
Between January 2003 and December 2007, 16 patients with respiratory failure required ECMO. Venovenous bypass and VA bypass were used in 9 cases (VV group) and 7 cases (VA group), respectively. The respiratory status before and during ECMO was compared between the two groups.
The percentage of patients requiring renal replacement therapy prior to ECMO use was significantly higher in the VA group than in the VV group. There were no significant differences between the two groups in PaO(2)/FIO(2), AaDO(2), pulmonary compliance, and the lung injury score prior to ECMO use. These parameters gradually improved in both groups; however, no significant intergroup differences were seen for up to 96 h after ECMO introduction. There was also no significant difference between the two groups in ECMO removal rate (VV group: 56%, VA group: 43%).
These results suggest that VV ECMO is comparable to VA ECMO, and can maintain sufficient respiratory support when VV ECMO is introduced to respiratory failure patients lacking evidence of renal and/or heart failure.
本研究比较了接受静脉-静脉（VV）和静脉-动脉（VA）体外膜肺氧合（ECMO）的患者在 ECMO 前后的呼吸状态，以评估呼吸衰竭患者选择 ECMO 的情况。
2003 年 1 月至 2007 年 12 月，16 例呼吸衰竭患者需要 ECMO。9 例（VV 组）和 7 例（VA 组）分别采用静脉-静脉旁路和静脉-动脉旁路。比较两组患者 ECMO 前后的呼吸状况。
VA 组患者在 ECMO 前需要肾替代治疗的比例明显高于 VV 组。两组患者在 ECMO 前的 PaO(2)/FIO(2)、AaDO(2)、肺顺应性和肺损伤评分均无显著差异。两组患者的这些参数均逐渐改善，但 ECMO 引入后 96 小时内两组间无显著差异。两组患者 ECMO 撤机率（VV 组：56%，VA 组：43%）也无显著差异。
这些结果表明，VV ECMO 与 VA ECMO 相当，当缺乏肾和/或心功能衰竭证据的呼吸衰竭患者引入 VV ECMO 时，可以维持足够的呼吸支持。
