Falk Lars, Fletcher-Sandersjöö Alexander, Hultman Jan, Broman Lars Mikael
ECMO Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176 Stockholm, Sweden.
Department of Physiology and Pharmacology, Karolinska Institutet, 171 76 Stockholm, Sweden.
Membranes (Basel). 2021 Mar 9;11(3):188. doi: 10.3390/membranes11030188.
No major study has been performed on the conversion from venovenous (VV) to venoarterial (VA) extracorporeal membrane oxygenation (ECMO) in adults. This single-center retrospective cohort study aimed to investigate the incidence, indication, and outcome in patients who converted from VV to VA ECMO. All adult patients (≥18 years) who commenced VV ECMO at our center between 2005 and 2018 were screened. Of 219 VV ECMO patients, 21% ( = 46) were converted to VA ECMO. The indications for conversion were right ventricular failure (RVF) (65%), cardiogenic shock (26%), and other (9%). In the converted patients, there was a significant increase in Sequential Organ Failure Assessment (SOFA) scores between admission 12 (9-13) and conversion 15 (13-17, < 0.001). Compared to non-converted patients, converted patients also had a higher mortality rate (62% vs. 16%, < 0.001) and a lower admission Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score ( < 0.001). Outcomes were especially unfavorable in those converted due to RVF. These results indicate that VA ECMO, as opposed to VV ECMO, should be considered as the first mode of choice in patients with respiratory failure and signs of circulatory impairment, especially in those with impaired RV function. For the remaining patients, Pre-admission RESP score, daily echocardiography, and SOFA score trajectories may help in the early identification of those where conversion from VV to VA ECMO is warranted. Multi-centric studies are warranted to validate these findings.
目前尚未有针对成人患者从静脉-静脉（VV）体外膜肺氧合（ECMO）转换为静脉-动脉（VA）ECMO的大型研究。这项单中心回顾性队列研究旨在调查从VV转换为VA ECMO的患者的发生率、转换指征及转归情况。我们对2005年至2018年间在本中心开始接受VV ECMO治疗的所有成年患者（≥18岁）进行了筛查。在219例接受VV ECMO治疗的患者中，21%（n = 46）转换为VA ECMO。转换的指征包括右心室衰竭（RVF）（65%）、心源性休克（26%）和其他（9%）。在转换的患者中，序贯器官衰竭评估（SOFA）评分在入院时为12（9 - 13），转换时为15（13 - 17），有显著升高（P < 0.001）。与未转换的患者相比，转换的患者死亡率也更高（62% vs. 16%，P < 0.001），入院时呼吸体外膜肺氧合生存预测（RESP）评分更低（P < 0.001）。因RVF而转换的患者预后尤其不佳。这些结果表明，与VV ECMO不同，对于有呼吸衰竭和循环功能障碍迹象的患者，尤其是右心室功能受损的患者，应将VA ECMO视为首选的初始模式。对于其余患者，入院前RESP评分、每日超声心动图检查以及SOFA评分轨迹可能有助于早期识别那些有必要从VV转换为VA ECMO的患者。有必要开展多中心研究以验证这些发现。
