Pandya Nischal R, Daley Michael, Mattke Adrian, Shikata Fumiaki, Betts Kim, Haisz Emma, Black Anthony, Anderson Benjamin, Alphonso Nelson, Venugopal Prem
Department of Cardiac Surgery, Lady Cilento Children's Hospital, Brisbane, Australia.
School of Medicine, University of Queensland, Brisbane, Australia.
Eur J Cardiothorac Surg. 2019 Jan 29. doi: 10.1093/ejcts/ezy485.
The aim of the study is to compare a technique of pump-controlled retrograde trial off (PCRTO) to insertion of an arterio-venous (AV) bridge to conduct a trial from venoarterial extracorporeal membrane oxygenation (VA ECMO).
We studied all patients who were weaned from VA ECMO using either PCRTO or AV bridging from November 2014 to April 2018. Demographic data, indications for ECMO, duration of ECMO, duration of trial period off ECMO and survival were compared between the 2 groups.
Seventy-nine patients were placed on VA ECMO from November 2014 to April 2018, of whom, 51 (65%) patients met the study inclusion criteria: 31 (61%) patients who had a trial period from VA ECMO using PCRTO and 20 (39%) patients who were weaned using an AV bridge. The indications for ECMO included cardiac (n = 16 and 11, respectively) and non-cardiac aetiologies (n = 15 and 9, respectively). There was 1 death in each group. The duration of the trial off VA ECMO was significantly shorter in the PCRTO group (median = 88.0 vs 196.6 min, P < 0.001). There were 2 conversions from PCRTO to AV bridging during the trial period off ECMO (2.9-kg neonate following a Norwood procedure and 2.2-kg patient following repair of ectopia cordis).
PCRTO is a safe, simple and reproducible approach for enabling a trial period while preserving the circuit during weaning from VA ECMO. In our study, the duration of the trial period off VA ECMO was significantly shorter in the PCRTO group. PCRTO avoids manipulation of the ECMO circuit, provides a 'stress test' to evaluate cardiorespiratory reserve during the trial period off ECMO, is applicable for a wide variety of cardiac and non-cardiac indications and facilitates multiple attempts at weaning from ECMO.
本研究旨在比较泵控逆行试验关闭（PCRTO）技术与动静脉（AV）桥接技术在静脉-动脉体外膜肺氧合（VA ECMO）撤机试验中的应用。
我们研究了2014年11月至2018年4月期间使用PCRTO或AV桥接技术从VA ECMO撤机的所有患者。比较两组患者的人口统计学数据、ECMO指征、ECMO持续时间、ECMO撤机试验期持续时间和生存率。
2014年11月至2018年4月期间，79例患者接受了VA ECMO治疗，其中51例（65%）患者符合研究纳入标准：31例（61%）患者采用PCRTO技术进行VA ECMO撤机试验，20例（39%）患者采用AV桥接技术撤机。ECMO的指征包括心脏病因（分别为n = 16和11）和非心脏病因（分别为n = 15和9）。每组各有1例死亡。PCRTO组VA ECMO撤机试验期明显更短（中位数分别为88.0分钟和196.6分钟，P < 0.001）。在ECMO撤机试验期间，有2例从PCRTO转换为AV桥接（1例2.9千克的新生儿接受诺伍德手术后，1例2.2千克的患者在修复心脏异位后）。
PCRTO是一种安全、简单且可重复的方法，可在VA ECMO撤机期间保留回路的同时进行撤机试验。在我们的研究中，PCRTO组VA ECMO撤机试验期明显更短。PCRTO避免了对ECMO回路的操作，在ECMO撤机试验期间提供了一项“压力测试”以评估心肺储备，适用于多种心脏和非心脏指征，并便于多次尝试从ECMO撤机。
