From the Department of General Surgery, Division of Trauma and Acute Care Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Harborview Medical Center, University of Washington, Seattle, Washington.
ASAIO J. 2021 Aug 1;67(8):e140-e144. doi: 10.1097/MAT.0000000000001305.
Despite overall improvements in critical care, mortality from acute respiratory distress syndrome (ARDS) remains high. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is used to rescue patients with severe ARDS. Although V-V ECMO can be life-saving, there are significant risks associated with this therapy. Hemorrhage is one of the most common complications. Therefore, some providers are reluctant to use V-V ECMO in patients with severe ARDS who concurrently have a high risk of bleeding or recent active hemorrhage. Several studies have been published detailing the safety of heparin-sparing or completely heparin-free anticoagulation strategies in patients on V-V ECMO. We present the cases of two patients with hemorrhagic shock and ongoing transfusion requirements who developed severe and refractory ARDS while in the operating room for hemorrhage control. After the massive bleeding was stopped, both patients were placed on V-V ECMO and were managed with minimal or no therapeutic anticoagulation for the duration of their course on V-V ECMO. Both patients required multiple operations and procedures while on V-V ECMO and there were no significant hemorrhagic complications. In conclusion, V-V ECMO can be considered for use in select patients with severe ARDS and high risk of hemorrhage, active hemorrhage, or ongoing transfusion requirements.
尽管重症监护整体有所改善，但急性呼吸窘迫综合征（ARDS）的死亡率仍然很高。静脉-静脉体外膜肺氧合（V-V ECMO）用于抢救严重 ARDS 患者。虽然 V-V ECMO 可以救命，但这种治疗方法存在很大的风险。出血是最常见的并发症之一。因此，一些提供者不愿意在并发高出血风险或近期有活动性出血的严重 ARDS 患者中使用 V-V ECMO。已经发表了几项研究，详细介绍了 V-V ECMO 患者肝素节约或完全无肝素抗凝策略的安全性。我们介绍了两名在手术室进行出血控制时发生出血性休克和持续输血需求的患者的病例，他们发展为严重和难治性 ARDS。大量出血停止后，两名患者均接受 V-V ECMO 治疗，并在 V-V ECMO 治疗期间接受最小或无治疗性抗凝治疗。两名患者在 V-V ECMO 期间均需要多次手术和操作，没有明显的出血并发症。总之，对于严重 ARDS 且有高出血风险、活动性出血或持续输血需求的患者，可以考虑使用 V-V ECMO。
