Intensive Care Unit, Queen Elizabeth Hospital, Kowloon, Hong Kong.
Perfusion. 2021 Nov;36(8):803-807. doi: 10.1177/0267659120971998. Epub 2020 Nov 17.
When veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support can be terminated, open repair of arteriotomy wounds in operating theaters is the standard of practice. Comparable outcomes by percutaneous decannulation using different closure devices have been reported. However, transport of the critically- ill, man-power and timeslots of operating theaters could be saved if decannulation was performed at bedside.
Bedside percutaneous arteriotomy wound closure became our default method of decannulation since November 2018. We reviewed our 1-year data to evaluate if such practice could be safely adopted in a local high-ECMO-volume center.
Between November 2018 and October 2019, 25 patients had their VA-ECMO terminated at the bedside. Twenty-one patients (84%) had successful decannulation. For those who failed, emergency open repair resulted in no additional complications. Two ProGlide devices were used in 15 (71.4%) patients and three were used in 6 (28.6%) patients. The procedure time was 27 (15-45) min. The median blood loss was 300 mL (250-400). Minor complications were found in 4 (19.1%) patients, including two arterial clot formation, one pseudoaneurysm and one wound infection. There were no other major complications.
Our 1-year experience showed that percutaneous bedside VA-ECMO decannulation was feasible to commence in a local large-ECMO-volume center.
当静脉-动脉体外膜肺氧合（VA-ECMO）支持可以终止时，在手术室进行切开血管修复是标准的做法。使用不同的闭合装置进行经皮拔管已报告具有可比的结果。然而，如果可以在床边进行拔管，可以节省重症患者的转运、人力和手术室时间。
自 2018 年 11 月以来，床边经皮切开血管伤口闭合已成为我们的默认拔管方法。我们回顾了我们的 1 年数据，以评估这种做法是否可以在当地高 ECMO 量中心安全采用。
2018 年 11 月至 2019 年 10 月期间，有 25 名患者在床边终止了 VA-ECMO。21 名患者（84%）成功拔管。对于那些失败的患者，紧急开放修复没有导致额外的并发症。21 名患者中使用了 2 个 ProGlide 装置（71.4%），6 名患者使用了 3 个装置（28.6%）。该过程用时 27（15-45）分钟。中位失血量为 300 毫升（250-400）。4 名患者（19.1%）出现轻微并发症，包括 2 例动脉血栓形成、1 例假性动脉瘤和 1 例伤口感染。没有其他严重并发症。
我们的 1 年经验表明，在当地大型 ECMO 量中心，开始床边经皮 VA-ECMO 拔管是可行的。
