St Vincent's Hospital Sydney, 390 Victoria St, Darlinghurst, NSW, 2010, Australia.
St Vincent's Hospital Sydney, 390 Victoria St, Darlinghurst, NSW, 2010, Australia.
Aust Crit Care. 2019 May;32(3):206-212. doi: 10.1016/j.aucc.2018.04.002. Epub 2018 May 29.
Reported rates of limb ischaemia on peripheral veno-arterial extracorporeal membrane oxygenation (pVA ECMO) vary from 1-52%.
Primary: To explore (i) the feasibility for appropriately trained intensive care unit staff to measure Doppler derived flow velocities of the lower limbs for patients on pVA ECMO; and (ii) whether these measurements are clinically useful. Secondary: explore the relationship between ECMO pump flow, backflow cannulae (BFC) properties, mean arterial blood pressure (MAP), and pulse pressure on flow velocities.
Inclusion criteria: age>18 years, on pVA ECMO >24 hours.
any guardianship limitations and patients without a BFC. Serial patients receiving pVA-ECMO over a 10 month period had Doppler derived flow velocities of the lower limbs sampled. Simultaneously, other pertinent parameters were recorded. 80% inclusion was considered clinically feasible. Study personnel were asked for feedback regarding the ease and usefulness of studies.
15 of 17 patients were included: 88% inclusion. Mean peak systolic velocity (PSV) in the cannulated limb was 31 ± 29 cm/s in the dorsalis pedis (DP) and 27 ± 18 cm/s posterior tibial (PT). Similar flows were recorded in the non-cannulated limbs (DP 34 ± 29 cm/s, PT 44 ± 36 cm/s; P > 0.05). PSV was positively correlated with pulse pressure in cannulated and non-cannulated limbs respectively (r=0.63, P < 0.05; r=0.67 and P < 0.05). There was no significant correlation between PSV and MAP. ECMO pump flow and BFC were negatively correlated with PSV (r=-0.51, P < 0.05; r=-0.43, P < 0.05).
It is generally feasible for ICU staff to measure flow velocities of the lower limbs for patients on pVA ECMO. It remains unclear how clinically useful these measurements are. Doppler derived flow velocities of arteries of the lower limbs of patients on pVA ECMO appear different to non-ECMO patients. PSV in the lower limbs of patients on pVA ECMO seems to be more related to pulse pressure than to other haemodynamic parameters.
外周静脉-动脉体外膜肺氧合（pVA ECMO）的肢体缺血报告率为 1-52%。
主要目的：探索（i）经过适当培训的重症监护病房工作人员是否能够测量接受 pVA ECMO 治疗的患者下肢的多普勒衍生流速；以及（ii）这些测量是否具有临床意义。次要目的：探索 ECMO 泵流量、回流导管（BFC）特性、平均动脉压（MAP）和脉搏压与流速之间的关系。
纳入标准：年龄>18 岁，接受 pVA ECMO 治疗>24 小时。
任何监护限制和没有 BFC 的患者。在 10 个月的时间内，对接受 pVA-ECMO 治疗的连续患者进行下肢多普勒衍生流速采样。同时，记录其他相关参数。80%的纳入被认为具有临床可行性。研究人员被要求对研究的便利性和有用性进行反馈。
17 名患者中有 15 名（88%的纳入率）被纳入研究。接受插管肢体的峰值收缩速度（PSV）在足背动脉（DP）为 31±29cm/s，在胫骨后动脉（PT）为 27±18cm/s。非插管肢体的流速相似（DP 34±29cm/s，PT 44±36cm/s；P>0.05）。PSV 与插管和非插管肢体的脉搏压呈正相关（r=0.63，P<0.05；r=0.67 和 P<0.05）。PSV 与 MAP 之间无显著相关性。ECMO 泵流量和 BFC 与 PSV 呈负相关（r=-0.51，P<0.05；r=-0.43，P<0.05）。
对于 ICU 工作人员来说，测量接受 pVA ECMO 治疗的患者下肢流速通常是可行的。目前尚不清楚这些测量在临床上有多大用处。接受 pVA ECMO 治疗的患者下肢动脉的多普勒衍生流速与非 ECMO 患者不同。接受 pVA ECMO 治疗的患者下肢 PSV 似乎与脉搏压比其他血流动力学参数更相关。
