Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany.
Heart Centre 5K12, University Hospital Ghent, Ghent, Belgium.
PLoS One. 2018 Jun 1;13(6):e0198392. doi: 10.1371/journal.pone.0198392. eCollection 2018.
Over the past decade, veno-venous extracorporeal membrane oxygenation (vvECMO) has been increasingly utilized in respiratory failure in patients. This study presents our institution´s experience focusing on the life span of ECMO systems reflecting the performance of a particular system. A retrospective review of our ECMO database identified 461 adult patients undergoing vvECMO (2010-2017). Patients that required more than one system and survived the first exchange >24 hours (n = 139) were included. Life span until the first exchange and exchange criteria were analyzed for all systems (PLS, Cardiohelp HLS-set, both Maquet Cardiopulmonary, Rastatt, Germany; Deltastream/Hilite7000LT, iLA-activve, Xenios/NovaLung, Heilbronn, Germany; ECC.O5, LivaNova, Mirandola, Italy). At our ECMO center, the frequency of a system exchange was 30%. The median (IQR) life span was 9 (6-12) days. There was no difference regarding the different systems (p = 0.145 and p = 0.108, respectively). However, the Deltastream systems were exchanged more frequently due to elective technical complications (e. g. worsened gas transfer, development of coagulation disorder, increased bleedings complications) compared to the other exchanged systems (p = 0.013). In summary, the used ECMO systems are safe and effective for acute respiratory failure. There is no evidence for the usage of a specific system. Only the increased predictability of an imminent exchange preferred the usage of a Deltastream system. However, the decision to use a particular system should not depend solely on the possible criteria for an exchange.
在过去的十年中,静脉-静脉体外膜肺氧合(vvECMO)在呼吸衰竭患者中的应用越来越广泛。本研究介绍了我们机构的经验,重点是反映特定系统性能的 ECMO 系统的寿命。对我们的 ECMO 数据库进行回顾性分析,确定了 461 名接受 vvECMO 的成年患者(2010-2017 年)。纳入需要更换超过一个系统且首次更换后存活时间>24 小时的患者(n=139)。分析了所有系统的首次更换前的寿命和更换标准(PLS、Cardiohelp HLS-set、均为 Maquet Cardiopulmonary,Rastatt,德国;Deltastream/Hilite7000LT、iLA-activve、Xenios/NovaLung,Heilbronn,德国;ECC.O5、LivaNova,Mirandola,意大利)。在我们的 ECMO 中心,系统更换的频率为 30%。中位(IQR)寿命为 9(6-12)天。不同系统之间无差异(分别为 p=0.145 和 p=0.108)。然而,与其他更换系统相比,由于选择的技术并发症(例如气体交换恶化、凝血功能障碍发展、出血并发症增加),Deltastream 系统更换更为频繁(p=0.013)。总之,所使用的 ECMO 系统在急性呼吸衰竭中是安全有效的。没有证据表明使用特定系统的优势。只有增加对即将到来的更换的可预测性,才更倾向于使用 Deltastream 系统。然而,使用特定系统的决策不应仅取决于更换的可能标准。