From the Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, University of Würzburg, Würzburg, Germany; and.
Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, University of Würzburg, Würzburg, Germany.
ASAIO J. 2021 Jan 1;67(1):67-73. doi: 10.1097/MAT.0000000000001202.
Different arterial cannulation strategies are feasible for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in postcardiotomy shock. We aimed to analyze potential benefits and safety of different arterial cannulation strategies. We identified 158 patients with postcardiotomy cardiogenic shock requiring VA-ECMO between 01/10 and 01/19. Eighty-eight patients were cannulated via axillary or femoral artery (group P), and 70 centrally via the ascending aorta directly or through an 8 mm vascular graft anastomosed to the ascending aorta (group C). Demographics and operative parameters were similar. Change of cannulation site for Harlequin's syndrome or hyperperfusion of an extremity occurred in 13 patients in group P but never in group C (p = 0.001). Surgical revision of cannulation site was also encountered more often in group P than C. The need for left ventricular (LV) unloading was similar between groups, whereas surgical venting was more often implemented in group C (11.4% vs. 2.3, p = 0.023). Stroke rates, renal failure, and peripheral ischemia were similar. Weaning rate from ECMO (52.9% vs. 52.3%, p = NS) was similar. The 30 day mortality was higher in group P (60% vs. 76.1%, p = 0.029). Central cannulation for VA-ECMO provides antegrade flow without Harlequin's syndrome, changes of arterial cannula site, and better 30 day survival. Complication rates regarding need for reexploration and transfusion requirements were similar.
不同的动脉置管策略可用于心脏手术后休克的静脉-动脉体外膜肺氧合（VA-ECMO）。我们旨在分析不同动脉置管策略的潜在益处和安全性。我们确定了 2010 年 1 月至 2019 年 1 月期间 158 例需要 VA-ECMO 的心脏手术后心源性休克患者。88 例经腋动脉或股动脉置管（P 组），70 例经升主动脉正中置管，直接或通过 8mm 血管移植物与升主动脉吻合（C 组）。两组患者的人口统计学和手术参数相似。P 组有 13 例发生 Harlequin 综合征或肢体过度灌注，而 C 组从未发生（p = 0.001）。P 组更常需要手术修正置管部位，而 C 组则更常需要左心室（LV）卸载。两组之间需要外科通气的比例相似，但 C 组（11.4%比 2.3%，p = 0.023）更常见。卒中率、肾衰竭和外周缺血相似。两组患者从 ECMO 脱机率（52.9%比 52.3%，p = NS）相似。P 组 30 天死亡率较高（60%比 76.1%，p = 0.029）。VA-ECMO 中央置管可提供顺行血流，不会发生 Harlequin 综合征、动脉置管部位改变和更好的 30 天存活率。关于需要再次探查和输血需求的并发症发生率相似。
