无全身抗凝的静脉-静脉体外膜肺氧合的可行性。
Feasibility of Venovenous Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation.
机构信息
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
出版信息
Ann Thorac Surg. 2020 Oct;110(4):1209-1215. doi: 10.1016/j.athoracsur.2020.02.011. Epub 2020 Mar 12.
BACKGROUND
Venovenous extracorporeal membrane oxygenation (ECMO) is increasingly being used for acute respiratory distress syndrome and as a bridge to lung transplantation. After initiation of venovenous ECMO, systemic anticoagulation therapy is traditionally administered and can cause bleeding diathesis. Here, we investigated whether venovenous ECMO can be administered without continuous systemic anticoagulation administration for patients with acute respiratory distress syndrome.
METHODS
This is a retrospective review of an institutional ECMO database. We included consecutive patients from January 2015 through February 2019. Overall, 38 patients received low levels of continuous systemic anticoagulation (AC+) whereas the subsequent 36 patients received standard venous thromboprophylaxis (AC-). Published Extracorporeal Life Support Organization guidelines were used for the definition of outcomes and complications.
RESULTS
Overall, survival was not different between the two groups (P = .58). However, patients in the AC+ group had higher rates of gastrointestinal bleeding (28.9%, vs AC- group 5.6%; P < .001). The events per patient-day of gastrointestinal bleeding was 0.00025 in the AC- group and 0.00064 in the AC+ group (P < .001). In addition, oxygenator dysfunction was increased in the AC+ group (28.9% and 0.00067 events per patient-day, vs AC- 11.1% and 0.00062 events per patient-day; P = .02). Furthermore, the AC+ group received more transfusions: packed red blood cells, AC+ group 94.7% vs AC- group 55.5% (P < .001); fresh frozen plasma, AC+ 60.5% vs AC- 16.6% (P = .001); and platelets, AC+ 84.2% vs AC- 27.7% (P < .001). There was no circuit thrombosis in either groups throughout the duration of ECMO support.
CONCLUSIONS
Our results suggest that venovenous ECMO can be safely administered without continuous systemic anticoagulation therapy. This approach may be associated with reduced bleeding diathesis and need for blood transfusions.
背景
静脉-静脉体外膜肺氧合（ECMO）越来越多地用于急性呼吸窘迫综合征，并作为肺移植的桥梁。静脉-静脉 ECMO 启动后，传统上给予全身抗凝治疗，但可能导致出血倾向。在这里，我们研究了急性呼吸窘迫综合征患者是否可以在不连续全身抗凝治疗的情况下进行静脉-静脉 ECMO。
方法
这是对机构 ECMO 数据库的回顾性分析。我们纳入了 2015 年 1 月至 2019 年 2 月连续患者。总体而言，38 名患者接受低水平的连续全身抗凝（AC+），而随后的 36 名患者接受标准静脉血栓预防（AC-）。使用体外生命支持组织指南来定义结局和并发症。
结果
两组患者的总体生存率无差异（P=0.58）。然而，AC+组患者的胃肠道出血发生率更高（28.9%，AC-组为 5.6%；P<0.001）。AC-组的胃肠道出血事件发生率为每患者-天 0.00025，AC+组为 0.00064（P<0.001）。此外，AC+组的氧合器功能障碍增加（28.9%和每患者-天 0.00067 事件，AC-组为 11.1%和每患者-天 0.00062 事件；P=0.02）。此外，AC+组接受了更多的输血：浓缩红细胞，AC+组 94.7%，AC-组 55.5%（P<0.001）；新鲜冰冻血浆，AC+组 60.5%，AC-组 16.6%（P=0.001）；血小板，AC+组 84.2%，AC-组 27.7%（P<0.001）。在整个 ECMO 支持期间，两组均无回路血栓形成。
结论
我们的结果表明，静脉-静脉 ECMO 可以在不连续全身抗凝治疗的情况下安全进行。这种方法可能与减少出血倾向和输血需求有关。
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