在动静脉体外膜肺氧合中，积极放置肢体远段灌注导管。

Aggressive placement of distal limb perfusion catheter in venoarterial extracorporeal membrane oxygenation.

机构信息

Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.

出版信息

Int J Artif Organs. 2020 Dec;43(12):796-802. doi: 10.1177/0391398820917160. Epub 2020 Apr 20.

DOI:10.1177/0391398820917160

PMID:32308098

Abstract

OBJECTIVE

The aim of this study is to review the impacts of aggressive placement of a distal perfusion catheter on the outcomes in patients supported with venoarterial extracorporeal membrane oxygenation via femoral cannulation.

METHODS

Analysis was performed with 143 consecutive femoral venoarterial extracorporeal membrane oxygenation cannulation. Patients were divided into two groups: the early period (October 2010 to December 2012, = 47) where placement of a distal perfusion catheter was attempted percutaneously but not surgically and the late period (January 2013 to November 2018, = 96) in which placement of distal perfusion catheter was aggressively utilized both percutaneously and surgically. The modification of venoarterial extracorporeal membrane oxygenation cannulation protocol for the late period involved (1) an immediate insertion of a distal perfusion catheter regardless of the size of femoral arterial cannula, (2) an open insertion of a distal perfusion catheter if percutaneous approach failed, and (3) when venoarterial extracorporeal membrane oxygenation cannulation was completed at a non-extracorporeal membrane oxygenation cannulation center, it was encouraged that they attempt insertion of a distal perfusion catheter at the time of cannulation.

RESULTS

In the late period, a distal perfusion catheter was placed in 96% (92/96) which was significantly increased from 66% (31/47) in the early period. Of these 92 patients in late period, nine patients (9.8%) required open direct insertion of a distal perfusion catheter. The incidence of lower limb ischemia (early vs. late period 26% vs 12%, = 0.031) was significantly decreased in the late period. Logistic regression analyses showed that distal perfusion catheter placement was the only factor for preventing lower limb ischemia.

CONCLUSION

Aggressive insertion of a distal perfusion catheter even utilizing surgical cut-down technique was shown to decrease the incidence of distal limb complications.

摘要

目的

本研究旨在回顾经股动脉插管行静脉-动脉体外膜肺氧合（VA-ECMO）时，积极放置远端灌注导管对患者预后的影响。

方法

对 143 例连续股动静脉 ECMO 插管患者进行分析。患者分为两组：早期（2010 年 10 月至 2012 年 12 月，47 例）尝试经皮但未行手术放置远端灌注导管，晚期（2013 年 1 月至 2018 年 11 月，96 例）经皮和手术积极使用远端灌注导管。晚期 ECMO 插管方案的修改包括：（1）立即插入远端灌注导管，而不考虑股动脉插管的大小；（2）如果经皮方法失败，则开放插入远端灌注导管；（3）如果 VA-ECMO 插管在非 ECMO 插管中心完成，鼓励他们在插管时尝试插入远端灌注导管。

结果

在晚期，96%（92/96）的患者放置了远端灌注导管，明显高于早期的 66%（31/47）。在晚期的 92 例患者中，有 9 例（9.8%）需要开放直接插入远端灌注导管。晚期下肢缺血的发生率（早期 vs. 晚期 26% vs. 12%，=0.031）显著降低。Logistic 回归分析显示，放置远端灌注导管是预防下肢缺血的唯一因素。