Jia L J, Du Z T, Liu Y Z, Xin M, Jiang C J, Xing Z C, Cui Y C, Xu B, Li C L, Guo D, Hou X T
Department of Critical Care Medicine, Beijing Chuiyangliu Hospital, Tsinghua University, Beijing 100022, China.
Intensive Care Unit for Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2020 May 26;100(20):1544-1550. doi: 10.3760/cma.j.cn112137-20191029-02335.
To Summarize the experience of pump-controlled retrograde trial off (PCRTO) in the process of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) withdrawal in adult patients. Adult patients who received ECMO assistance in Intensive Care Unit for Cardiac Surgery from March to July 2019 were collected. According to our strategies, PCRTO was used if the patients can wean from VA-ECMO and hemodynamic indexes were recorded during the process. The statistics data was collected, including the 48 hours survival rate, ECMO re-assistance rate, thrombus complications, Intensive Care Unit (ICU) stay time and hospital stay time after weaning from VA-ECMO. The patients who failed in the test were continued to be assisted by ECMO. There were 46 patients assisted by VA-ECMO in our center. In total, 21 adults who met the offline test standard underwent 26 PCRTOs, including 10 male adults (47.6%), with an age of 65 (55, 68) years old. Eighteen adults passed the withdrawal test. No new thrombus was found in the arteriovenous ultrasound of the lower extremity after weaning from ECMO, and no pulmonary embolism was found in the chest X-ray. The success rate of weaning from ECMO was 69.23%(18/26). The D-dimer decreased [584(348,2 107)μg/L vs 1 440(631,2 916)μg/L, 0.014] and the left ventricular ejection fraction (LVEF) increased (51.4%±8.5% vs 46.9%±10.6%, 0.013) on the next day after weaning. There were significant differences in heart rate (HR), central venous pressure (CVP), oxygenation index and lactate (Lac) during the PCRTO in the group which involved the cases of the 8 failed experiments (all 0.05). Compared with the failure group, there were significant differences in age, blood flow rate, CVP before the test, HR, pulse oxygen saturation(SpO(2)), CVP, Lac and oxygenation index after the test, and the variations of SpO(2), CVP and Lac. PCRTO is a simple, reversible, safe and effective weaning method. It can be used in the process of VA-ECMO withdrawal in adult patients.
总结成人患者静脉-动脉体外膜肺氧合（VA-ECMO）撤机过程中泵控逆行试验脱机（PCRTO）的经验。收集2019年3月至7月在心脏外科重症监护病房接受ECMO辅助的成人患者。根据我们的策略，如果患者能够从VA-ECMO撤机，则采用PCRTO，并记录撤机过程中的血流动力学指标。收集统计数据，包括48小时生存率、ECMO再次辅助率、血栓并发症、重症监护病房（ICU）住院时间以及从VA-ECMO撤机后的住院时间。试验失败的患者继续接受ECMO辅助。本中心有46例患者接受了VA-ECMO辅助。共有21例符合脱机试验标准的成人患者进行了26次PCRTO，其中男性成人10例（47.6%），年龄为65（55，68）岁。18例成人患者通过了撤机试验。撤机后下肢动静脉超声未发现新的血栓，胸部X线检查未发现肺栓塞。ECMO撤机成功率为69.23%（18/26）。撤机后次日D-二聚体下降[584（348，2107）μg/L对1440（631，2916）μg/L，P=0.014]，左心室射血分数（LVEF）升高（51.4%±8.5%对46.9%±10.6%，P=0.013）。在涉及8例失败试验病例的组中，PCRTO期间心率（HR）、中心静脉压（CVP）、氧合指数和乳酸（Lac）有显著差异（均P<0.05）。与失败组相比，年龄、血流量、试验前CVP、HR、脉搏血氧饱和度（SpO₂）、试验后CVP、Lac和氧合指数以及SpO₂、CVP和Lac的变化有显著差异。PCRTO是一种简单、可逆、安全有效的撤机方法。它可用于成人患者VA-ECMO撤机过程。
