Kuhl Thomas, Michels Guido, Pfister Roman, Wendt Stefanie, Langebartels Georg, Wahlers Thorsten
Practice of Cardiology, Dormagen, Germany.
Department III of Internal Medicine, Heartcenter of the University of Cologne, Germany.
Thorac Cardiovasc Surg. 2015 Dec;63(8):653-62. doi: 10.1055/s-0035-1549359. Epub 2015 May 6.
Comparison of two kinds of cannulation (double-lumen cannula [DLC, Avalon Elite Bicaval Dual Lumen Catheter] and conventional cannulation with two cannulas) for venovenous extracorporeal membrane oxygenation (ECMO) therapy in terms of effectiveness, usage complexity, and costs.
Retrospective case series of 17 patients who received venovenous ECMO therapy due to acute respiratory distress syndrome (ARDS) between January 2010 and March 2012. Nine patients were treated with the DLC and eight patients with conventional cannulation. We analyzed the outcome data, ECMO values, respirator settings, blood gas values, realized prone positioning, and costs, and compared both methods.
Both kinds of cannulation are efficient regarding oxygenation and decarboxylation. There is no significant difference in mortality, hospitalization time (intensive care unit [ICU] and hospital) and complications during ECMO therapy between both groups. Cannula implantation is much more complex in the DLC group and requires more experience in TEE (transesophageal echocardiography) diagnostics and cannulation technique. In addition, the costs for the Avalon (MAQUET Cardiopulmonary AG, Germany) cannula are significantly higher than for conventional cannulation. Furthermore, prone positioning could be easier achieved in the DLC group.
In summary, double-lumen cannulation allows sufficient gas exchange with more effort (material, technical, and physicians' experience) and higher costs but better mobilization possibilities (particularly prone position) and potential avoidance of deep sedation and mechanical ventilation. From the current point of view, the DLC should be reserved for special cases.
比较两种插管方式（双腔插管[DLC，Avalon Elite双腔双腔导管]和传统的双套管插管）用于静脉-静脉体外膜肺氧合（ECMO）治疗的有效性、使用复杂性和成本。
回顾性病例系列研究，纳入2010年1月至2012年3月期间因急性呼吸窘迫综合征（ARDS）接受静脉-静脉ECMO治疗的17例患者。9例患者采用DLC治疗，8例患者采用传统插管治疗。我们分析了结局数据、ECMO参数、呼吸机设置、血气值、实施俯卧位情况和成本，并比较了两种方法。
两种插管方式在氧合和脱羧方面均有效。两组在ECMO治疗期间的死亡率、住院时间（重症监护病房[ICU]和医院）及并发症方面无显著差异。DLC组的插管植入要复杂得多，需要更多经食管超声心动图（TEE）诊断和插管技术方面的经验。此外，Avalon（德国迈柯唯心肺公司）套管的成本显著高于传统插管。此外，DLC组更容易实现俯卧位。
总之，双腔插管能实现充分的气体交换，但需要更多努力（材料、技术和医生经验）且成本更高，但具有更好的活动可能性（特别是俯卧位）以及可能避免深度镇静和机械通气。从目前来看，DLC应保留用于特殊情况。
