Cummins Carole, Bentley Andrew, McAuley Daniel F, McNamee James J, Patrick Hannah, Barrett Nicholas A
Institute of Applied Health Research, University of Birmingham, UK.
2Acute Intensive Care Unit, University Hospital of South Manchester NHS Foundation Trust, UK.
J Intensive Care Soc. 2018 May;19(2):114-121. doi: 10.1177/1751143717739816. Epub 2017 Nov 13.
Extracorporeal membrane carbon dioxide removal may have a role in treatment of patients with hypercapnic respiratory failure and refractory hypoxaemia and/or hypercapnia.
We report on the use, outcomes and complications in United Kingdom intensive care units reporting patients on the Extracorporal Life Support Organisation register.
Of 60 patients, 42 (70%) had primarily hypoxic respiratory failure and 18 (30%) primarily hypercapnic respiratory failure. Use of veno-venous procedures increased compared to arterio-venous procedures. Following extracorporeal membrane carbon dioxide removal, ventilatory and blood gas parameters improved at 24 h. Twenty-seven (45%) of patients died before ICU discharge, while 27 (45%) of patients were discharged alive. The most common complications related to thrombosis or haemorrhage.
There is limited use of extracorporeal membrane carbon dioxide removal in UK clinical practice and outcomes reflect variability in indications and the technology used. Usage is likely to increase with the availability of new, simpler, technology. Further high quality evidence is needed.
体外膜肺氧合二氧化碳清除技术可能在治疗高碳酸血症性呼吸衰竭及难治性低氧血症和/或高碳酸血症患者中发挥作用。
我们报告了英国重症监护病房中使用体外膜肺氧合二氧化碳清除技术的情况、治疗结果及并发症，这些重症监护病房上报了在体外生命支持组织登记的患者信息。
60例患者中，42例（70%）主要为低氧性呼吸衰竭，18例（30%）主要为高碳酸血症性呼吸衰竭。与动静脉置管程序相比，静脉-静脉置管程序的使用有所增加。体外膜肺氧合二氧化碳清除技术应用后，通气和血气参数在24小时时有所改善。27例（45%）患者在重症监护病房出院前死亡，27例（45%）患者存活出院。最常见的并发症与血栓形成或出血有关。
在英国临床实践中，体外膜肺氧合二氧化碳清除技术的使用有限，治疗结果反映出适应证和所使用技术的差异。随着新型、更简单技术的出现，其使用可能会增加。还需要进一步的高质量证据。
