Cakici Mehmet, Ozcinar Evren, Baran Cagdas, Bermede Ahmet Onat, Sarıcaoglu Mehmet Cahit, Inan Mustafa Bahadır, Durdu Mustafa Serkan, Aral Atilla, Sirlak Mustafa, Akar Ahmet Ruchan
1 Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey.
2 Department of Anesthesiology and Reanimation, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey.
Perfusion. 2017 Jul;32(5):363-371. doi: 10.1177/0267659116683792. Epub 2016 Dec 1.
This study was designed to compare vascular complications and the outcomes of ultrasound (US)-guided percutaneous cannulation with distal perfusion catheter (PC-DP) and arterial side-graft perfusion (SGP) techniques in patients who require veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for refractory cardiogenic shock (RCS).
We conducted a retrospective, observational cohort study of consequtive patients with RCS treated with VA-ECMO at a single transplant center from March 2010 until August 2015. Overall, 148 patients underwent VA-ECMO for RCS (99 men, aged 56.6 ± 12.0 years; BSA, 1.85 ± 0.19). Patients were categorized based on VA-ECMO perfusion technique into PC-DP via femoral artery and SGP via axillary/femoral artery groups.
The median duration of VA-ECMO support was 5 days (range, 8 hours-80 days). Hospital mortality (PC-DP group, 54.7%; SGP group, 64.4%; p=0.23) and overall ECMO survival (PC-DP group, 36.9%; SGP group, 32.2%; p=0.47) was similar between the groups. There were no significant between-group differences in the rate of acute limb ischemia (PC-DP group, 4/75, 5.3%; SGP group, 2/73, 2.7%; p=0.68). However, the rate of surgical/cannulation site bleeding (PC-DP, 9/75 (12%) vs SGP, 18/73 (24.7%), p=0.05) and hyperperfusion syndrome (PC-DP, 2/75 (2.7%) vs SGP, 22/73 (30.1%),p=0.001) were higher in the SGP group than in the PC-DP group.
We observed no significant difference in major vascular complications or survival between patients who underwent the PC-DP technique and those who underwent arterial SGP.
本研究旨在比较在需要静脉 - 动脉体外膜肺氧合（VA - ECMO）支持以治疗顽固性心源性休克（RCS）的患者中，超声（US）引导下经皮穿刺置入远端灌注导管（PC - DP）与动脉侧支移植灌注（SGP）技术的血管并发症及治疗结果。
我们对2010年3月至2015年8月在单一移植中心接受VA - ECMO治疗的连续性RCS患者进行了一项回顾性观察队列研究。总体而言，148例患者因RCS接受了VA - ECMO治疗（99例男性，年龄56.6±12.0岁；体表面积，1.85±0.19）。患者根据VA - ECMO灌注技术分为经股动脉的PC - DP组和经腋动脉/股动脉的SGP组。
VA - ECMO支持的中位持续时间为5天（范围，8小时 - 80天）。两组之间的医院死亡率（PC - DP组，54.7%；SGP组，64.4%；p = 0.23）和总体ECMO生存率（PC - DP组，36.9%；SGP组，32.2%；p = 0.47）相似。急性肢体缺血发生率在组间无显著差异（PC - DP组，4/75，5.3%；SGP组，2/73，2.7%；p = 0.68）。然而，手术/插管部位出血率（PC - DP组，9/75（12%）对SGP组，18/73（24.7%），p = 0.05）和高灌注综合征发生率（PC - DP组，2/75（2.7%）对SGP组，22/73（30.1%），p = 0.001）在SGP组高于PC - DP组。
我们观察到接受PC - DP技术的患者与接受动脉SGP技术的患者在主要血管并发症或生存率方面无显著差异。
