Ma Robert Wai-Leung, Huilgol Ravi L, Granger Emily, Jackson Andrew, Saling Samantha, Dower Ashraf, Nivison-Smith Ian
St Vincent's Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia.
ANZ J Surg. 2016 Dec;86(12):1002-1006. doi: 10.1111/ans.13441. Epub 2016 Feb 28.
Extracorporeal membrane oxygenation (ECMO) provides support to patients with severe but reversible cardiac or pulmonary failure. Vascular complications of ECMO are well recognized.
We performed a retrospective review of 70 patients (mean age 48 years; 15-85) who received peripheral veno-arterial ECMO from 2004 to 2010 in a single centre. For statistical analysis, chi-squared test and multivariate binary logistic regression analysis were used to assess for association between response variables (i.e. limb ischaemia, ECMO site bleeding and deep vein thrombosis (DVT)) and possible predictive variables.
There were 14 (20%) cases of acute limb ischaemia with no statistically significant relationship between acute limb ischaemia and independent variables. Thirty-three patients received distal limb cannulas (47%). There was no statistically significant association between limb ischaemia and presence of distal limb cannula (P = 0.8). Multivariate binary logistic regression analysis identified insertion by cutdown as a predictor of lower probability of insertion site bleeding (n = 12, odds ratio 0.24, P = 0.04). Seven cases of DVT were identified; multivariate binary logistic regression analysis identified insertion by cutdown (odds ratio 0.08, P = 0.03) and days of ECMO less than five (odds ratio 0.08, P = 0.04) as predictive factors for reduced rates of DVT.
Ischaemic complications of ECMO are common and occur despite the presence of a distal limb-perfusing cannula; however in our study the distal limb cannula was a limb-salvaging intervention in six patients. Prolonged time on ECMO is a risk factor for DVT, and a high index of suspicion must be maintained. Percutaneous insertion was associated with higher rates of bleeding and DVT.
体外膜肺氧合（ECMO）为患有严重但可逆性心脏或肺衰竭的患者提供支持。ECMO的血管并发症已得到充分认识。
我们对2004年至2010年在单一中心接受外周静脉-动脉ECMO的70例患者（平均年龄48岁；15 - 85岁）进行了回顾性研究。为进行统计分析，采用卡方检验和多变量二元逻辑回归分析来评估反应变量（即肢体缺血、ECMO部位出血和深静脉血栓形成（DVT））与可能的预测变量之间的关联。
有14例（20%）急性肢体缺血病例，急性肢体缺血与自变量之间无统计学显著关系。33例患者接受了远端肢体插管（47%）。肢体缺血与远端肢体插管的存在之间无统计学显著关联（P = 0.8）。多变量二元逻辑回归分析确定切开插管是插入部位出血概率较低的预测因素（n = 12，比值比0.24，P = 0.04）。确定了7例DVT病例；多变量二元逻辑回归分析确定切开插管（比值比0.08，P = 0.03）和ECMO天数少于5天（比值比0.08，P = 0.04）是DVT发生率降低的预测因素。
ECMO的缺血性并发症很常见，即使存在远端肢体灌注插管也会发生；然而在我们的研究中，远端肢体插管对6例患者起到了挽救肢体的作用。ECMO使用时间延长是DVT的一个危险因素，必须保持高度怀疑指数。经皮插入与更高的出血和DVT发生率相关。
