Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
Ann Thorac Surg. 2019 May;107(5):1389-1394. doi: 10.1016/j.athoracsur.2018.10.048. Epub 2018 Nov 30.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support can be associated with significant deconditioning due to the requirement for strict bedrest as a result of femoral arterial cannulation. To address this issue, we evaluated our experience with ambulation in patients with peripheral femoral cannulation for VA-ECMO.
All patients that were peripherally cannulated for VA-ECMO over a 2-year period were retrospectively reviewed. Patients that ambulated at least once while supported with VA-ECMO were included in the analysis. The primary outcomes were safety and feasibility of ambulation, defined as the absence of major bleeding, vascular, or decannulation events.
Of 104 patients placed on VA-ECMO, 15 ambulated with a femoral arterial cannula. Forty-six percent of patients were placed on VA-ECMO for decompensated heart failure, and 54% for massive pulmonary embolism. Twenty-seven percent of patients were cannulated during active cardiopulmonary resuscitation. The median length of time from cannulation to out of bed was 3 (range, 0 to 26) days. The median length of time from cannulation to initial ambulation was 4 (range, 1 to 42) days. The median distance of the first postcannulation walk was 300 feet. Neither flow nor speed decreased during or after ambulation. There were no major bleeding events, vascular complications, or decannulation events associated with ambulation. The median intensive care unit length of stay and hospital length of stay were 12 and 21 days, respectively. One-year survival was 100% for ambulating patients.
Ambulating patients supported with VA-ECMO, despite femoral arterial cannulation, appears feasible and safe in carefully selected patients.
由于股动脉插管需要严格卧床休息，静脉-动脉体外膜肺氧合（VA-ECMO）支持可能会导致明显的身体状况恶化。为了解决这个问题，我们评估了在外周股动脉插管的 VA-ECMO 患者中进行活动的经验。
回顾性分析了在 2 年内接受外周 VA-ECMO 插管的所有患者。分析纳入了至少接受过一次 VA-ECMO 支持下活动的患者。主要结局是活动的安全性和可行性，定义为无大出血、血管或脱管事件。
在 104 例接受 VA-ECMO 治疗的患者中，有 15 例带有股动脉插管进行活动。46%的患者因失代偿性心力衰竭而接受 VA-ECMO 治疗，54%的患者因大面积肺栓塞而接受治疗。27%的患者在心肺复苏期间进行了插管。从插管到下床的中位时间为 3 天（范围：0 至 26 天）。从插管到首次活动的中位时间为 4 天（范围：1 至 42 天）。第一次活动后的中位行走距离为 300 英尺。活动期间和活动后血流和速度均未下降。与活动相关的无大出血事件、血管并发症或脱管事件。患者的 ICU 中位住院时间和医院中位住院时间分别为 12 天和 21 天。接受活动的患者的 1 年生存率为 100%。
在外周股动脉插管的 VA-ECMO 支持下，尽管进行了股动脉插管，但在仔细选择的患者中，活动似乎是可行且安全的。
