Au Shek Yin, Fong Ka Man, Chan Kwong Shun, Yung Sai Kwong, Leung Rowlina Pui Wah, Leung Avis Siu Ha, So Sze Sze, Ng George Wing Yiu
Department of Intensive Care, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR.
Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR.
J Vasc Access. 2020 Nov;21(6):1017-1022. doi: 10.1177/1129729820913378. Epub 2020 Apr 28.
Veno-arterial extracorporeal membrane oxygenation is a form of mechanical circulatory support for patients with refractory decompensated heart failure. Blood is drawn from a large vein and pumped back to a large artery, usually a femoral artery through large bore catheters. When the heart recovers, the extracorporeal membrane oxygenation support can be terminated and the catheters are decannulated. The bleeding at the venous side can be controlled by prolonged compression; however, the arteriotomy wound needs to be repaired. Conventionally, the arteriotomy wounds require open vascular repair in the operating theater. The novel application of percutaneous vascular closure devices, which have been commonly used in vascular operations and percutaneous structural heart interventions, could be applied for closure of arteriotomy wounds at the bedside after extracorporeal membrane oxygenation support. The post-close ProGlide (Abbott Vascular) technique was shown to be safe and could potentially save time and manpower. The wounds are much smaller as compared with the conventional open repair and potentially, the chance of wound infection can be reduced. However, the success of percutaneous bedside closure requires careful prior planning and technique training. Backup plans with vascular surgeons' standby are essential in case of failure of closure. Staffs in the extracorporeal membrane oxygenation centers need to be familiar with the preparation, the procedure as well as the device application technique for successful percutaneous closure. The long learning curve and the limited case load mean that such skills are best trained by simulation scenarios. This article described how this new technique and the team logistics can be trained by simulation.
静脉-动脉体外膜肺氧合是一种为难治性失代偿性心力衰竭患者提供机械循环支持的方式。血液从大静脉引出，通过大口径导管泵回大动脉，通常是股动脉。当心脏恢复时，可终止体外膜肺氧合支持并拔除导管。静脉端的出血可通过延长压迫来控制；然而，动脉切开伤口需要修复。传统上，动脉切开伤口需要在手术室进行开放血管修复。经皮血管闭合装置在血管手术和经皮结构性心脏介入中已普遍使用，其新应用可用于在体外膜肺氧合支持后在床边闭合动脉切开伤口。术后使用ProGlide（雅培血管）技术显示是安全的，并且可能节省时间和人力。与传统的开放修复相比，伤口要小得多，并且可能降低伤口感染的几率。然而，经皮床边闭合的成功需要事先仔细规划和技术培训。万一闭合失败，血管外科医生随时待命的备用计划至关重要。体外膜肺氧合中心的工作人员需要熟悉经皮闭合成功所需的准备工作、操作过程以及设备应用技术。较长的学习曲线和有限的病例量意味着这种技能最好通过模拟场景进行培训。本文描述了如何通过模拟来培训这种新技术和团队协作。
