Stokes John W, Gannon Whitney D, Sherrill Wren H, Armistead Leslie B, Bacchetta Matthew, Rice Todd W, Semler Matthew W, Casey Jonathan D
Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
Crit Care Explor. 2020 Nov 9;2(11):e0267. doi: 10.1097/CCE.0000000000000267. eCollection 2020 Nov.
Bleeding and thromboembolism are common during venovenous extracorporeal membrane oxygenation. The relative frequency of these complications and their impact on clinical outcomes have not been described, and no randomized trials exist to guide anticoagulation strategies in extracorporeal membrane oxygenation. Our objective was to examine the relative frequencies of bleeding and thromboembolic events and their associations with survival among a cohort of consecutive patients receiving venovenous extracorporeal membrane oxygenation.
Retrospective cohort study.
A single academic medical center.
Adult patients receiving venovenous extracorporeal membrane oxygenation and anticoagulation. Eligibility criteria for this analysis were selected to emulate the population that would be recruited for a randomized trial of anticoagulation strategies during venovenous extracorporeal membrane oxygenation. Patients were excluded if they had active bleeding or thromboembolism prior to extracorporeal membrane oxygenation initiation, a history of trauma or surgery in the 7 days prior to extracorporeal membrane oxygenation initiation, an arterial extracorporeal membrane oxygenation cannula, or if they received greater than 48 hours of extracorporeal membrane oxygenation support at another institution.
None.
Outcomes included bleeding and thromboembolic events, duration of extracorporeal membrane oxygenation support, hospital length of stay, and in-hospital survival among 55 patients receiving venovenous extracorporeal membrane oxygenation. Bleeding events occurred in 25 patients (45.5%), and thromboembolism occurred in eight patients (14.5%). Bleeding events were associated with longer duration of extracorporeal membrane oxygenation support ( = 0.007) and worse in-hospital survival ( = 0.02). Thromboembolic events did not appear to be associated with clinical outcomes.
In this cohort of patients receiving venovenous extracorporeal membrane oxygenation and anticoagulation, bleeding occurred more frequently than thromboembolism and was associated with worse survival. These results highlight the need for randomized trials to evaluate the safety and efficacy of continuous IV anticoagulation among patients receiving venovenous extracorporeal membrane oxygenation.
在静脉-静脉体外膜肺氧合（VV-ECMO）期间出血和血栓栓塞很常见。这些并发症的相对发生率及其对临床结局的影响尚未见描述，且尚无随机试验来指导体外膜肺氧合的抗凝策略。我们的目的是在一组接受静脉-静脉体外膜肺氧合的连续患者中，研究出血和血栓栓塞事件的相对发生率及其与生存的关联。
回顾性队列研究。
一家学术医疗中心。
接受静脉-静脉体外膜肺氧合和抗凝治疗的成年患者。本分析的纳入标准是为模拟在静脉-静脉体外膜肺氧合期间进行抗凝策略随机试验时将招募的人群而选择的。如果患者在开始体外膜肺氧合之前有活动性出血或血栓栓塞、在开始体外膜肺氧合之前7天内有创伤或手术史、有动脉体外膜肺氧合插管，或者在其他机构接受了超过48小时的体外膜肺氧合支持，则将其排除。
无。
结局包括55例接受静脉-静脉体外膜肺氧合患者的出血和血栓栓塞事件、体外膜肺氧合支持持续时间、住院时间和院内生存率。25例患者（45.5%）发生出血事件，8例患者（14.5%）发生血栓栓塞。出血事件与更长的体外膜肺氧合支持持续时间（P = 0.007）和更差的院内生存率（P = 0.02）相关。血栓栓塞事件似乎与临床结局无关。
在这组接受静脉-静脉体外膜肺氧合和抗凝治疗的患者中，出血比血栓栓塞更常见，且与更差的生存率相关。这些结果凸显了需要进行随机试验以评估接受静脉-静脉体外膜肺氧合患者持续静脉内抗凝的安全性和有效性。
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