Wong Joshua K, Melvin Amber L, Joshi Devang J, Lee Candice Y, Archibald William J, Angona Ron E, Tchantchaleishvili Vakhtang, Massey Howard T, Hicks George L, Knight Peter A
Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Artif Organs. 2017 Sep;41(9):827-834. doi: 10.1111/aor.12880. Epub 2017 Jun 7.
Cannulation-related complications are a known source of morbidity in patients supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Despite its prevalence, little is known regarding the outcomes of patients who suffer such complications. This is a single institution review of cannulation-related complications and its effect on mortality in patients supported on VA-ECMO from January 2010-2015 using three cannulation strategies: axillary, femoral, and central. Complications were defined as advanced if they required major interventions (fasciotomy, amputation, site conversion). Patients were divided into two groups (complication present vs. not present) and Kaplan-Meier analysis was performed to determine any differences in their survival distributions. There were 103 patients supported on VA-ECMO: 41 (40%), 36 (35%), and 26 (25%) were cannulated via axillary, femoral, and central access, respectively. Cannulation-related complications occurred in 33 (32%) patients and this did not differ significantly between either axillary (34%), femoral (36%), or central (23%) strategies (P = 0.52). The most common complications encountered were hemorrhage and limb ischemia in 19 (18%) and 11 (11%) patients. Hemorrhagic complications did not differ between groups (P = 0.37), while limb ischemia and hyperperfusion were significantly associated with femoral and axillary cannulation, at a rate of 25% (P < 0.01) and 15% (P = 0.01), respectively. There was no difference in the incidence of advanced complications between cannulation groups: axillary (12%) vs. femoral (14%) vs. central (8%; P = 0.75). In addition, no increase in mortality was noted in patients who developed a cannulation-related complication by Kaplan-Meier estimates (P = 0.37). Cannulation-related complications affect a significant proportion of patients supported on VA-ECMO but do not differ in incidence between different cannulation strategies and do not affect patient mortality. Improved efforts at preventing these complications need to be developed to avoid the additional morbidity in an already critical patient population.
在接受静脉-动脉体外膜肺氧合（VA-ECMO）支持的患者中，插管相关并发症是已知的发病原因。尽管其很常见，但对于发生此类并发症的患者的预后知之甚少。这是一项单机构回顾性研究，分析了2010年1月至2015年期间接受VA-ECMO支持的患者中与插管相关的并发症及其对死亡率的影响，采用了三种插管策略：腋动脉、股动脉和中心静脉。如果并发症需要进行重大干预（筋膜切开术、截肢、部位转换），则定义为严重并发症。患者分为两组（有并发症组与无并发症组），进行Kaplan-Meier分析以确定其生存分布是否存在差异。共有103例接受VA-ECMO支持的患者：分别有41例（40%）、36例（35%）和26例（25%）通过腋动脉、股动脉和中心静脉插管。33例（32%）患者发生了插管相关并发症，在腋动脉（34%）、股动脉（36%）或中心静脉（23%）策略之间，这一比例无显著差异（P = 0.52）。最常见的并发症是出血和肢体缺血，分别有19例（18%）和11例（11%）患者发生。出血并发症在各组之间无差异（P = 0.37），而肢体缺血和肢体过度灌注分别与股动脉和腋动脉插管显著相关，发生率分别为25%（P < 0.01）和15%（P = 0.01）。插管组之间严重并发症的发生率无差异：腋动脉插管组为12%，股动脉插管组为14%，中心静脉插管组为8%（P = 0.75）。此外，根据Kaplan-Meier估计，发生插管相关并发症的患者死亡率没有增加（P = 0.37）。插管相关并发症影响了很大一部分接受VA-ECMO支持的患者，但不同插管策略之间的发生率没有差异，也不影响患者死亡率。需要加大预防这些并发症的力度，以避免在本已病情危急的患者群体中增加额外的发病率。
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