程序化每日评估准备撤离静脉-静脉体外膜肺氧合的安全性和可行性。
Safety and Feasibility of a Protocolized Daily Assessment of Readiness for Liberation From Venovenous Extracorporeal Membrane Oxygenation.
机构信息
Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN.
出版信息
Chest. 2021 Nov;160(5):1693-1703. doi: 10.1016/j.chest.2021.05.066. Epub 2021 Jun 21.
BACKGROUND
Decannulation from venovenous extracorporeal membrane oxygenation (ECMO) at the earliest and safest possible time may improve outcomes and reduce cost. Yet, no prospective studies have compared weaning strategies for liberation from ECMO.
RESEARCH QUESTION
Is a protocolized daily assessment of readiness to liberate from venovenous ECMO safe and feasible?
STUDY DESIGN AND METHODS
We conducted a prospective, single-arm safety and feasibility study of a protocol for daily assessment of readiness to liberate from venovenous ECMO among consecutive adult patients receiving venovenous ECMO across four ICUs at a single center between June 20, 2020, and November 24, 2020. The ECMO-free protocol included three phases: (1) the safety screening, (2) non-ECMO Fio titration, and (3) the ECMO-free trial. Enrollment, interventions, and data collection were performed prospectively by trained study staff.
RESULTS
Twenty-six patients received the ECMO-free protocol on 385 patient-days. The safety screening was passed during a total of 59 ECMO-free daily assessments (15.3%) among 20 patients. Every passed safety screening proceeded to an ECMO-free trial. Twenty-eight passed ECMO-free trials (47.5%) occurred among 16 patients (61.5%). No missed safety screenings, protocol deviations, or adverse events occurred. Of the 16 patients who passed an ECMO-free trial, 14 patients (87.5%) were decannulated. Among decannulated patients, 12 patients (85.7%) were decannulated on the same day as a passed ECMO-free trial, 6 patients (42.9%) were decannulated on the first day that they passed an ECMO-free trial, and 6 patients (42.9%) passed an ECMO-free trial at least twice consecutively before decannulation. The median time from first passed ECMO-free trial to decannulation was 2 days (interquartile range, 0-3 days).
INTERPRETATION
The ECMO-free protocol is feasible and may identify patients for decannulation earlier than gradual approaches to weaning.
背景
在尽可能早且安全的时间从静脉-静脉体外膜肺氧合（ECMO）中拔管可能会改善结果并降低成本。然而，目前还没有前瞻性研究比较 ECMO 撤离的撤机策略。
研究问题
每天评估准备从静脉-静脉 ECMO 中撤离的方案是否安全可行？
研究设计和方法
我们在 2020 年 6 月 20 日至 11 月 24 日期间，在一家中心的四个 ICU 中对连续接受静脉-静脉 ECMO 的成年患者进行了一项关于每天评估从静脉-静脉 ECMO 中撤离准备情况的方案的前瞻性、单臂安全性和可行性研究。ECMO 撤离方案包括三个阶段：（1）安全筛查，（2）非 ECMO FiO2 滴定，（3）ECMO 撤离试验。训练有素的研究人员前瞻性地进行了入组、干预和数据收集。
结果
26 名患者在 385 个患者日接受了 ECMO 撤离方案。在 20 名患者中，共有 59 次 ECMO 撤离日评估（15.3%）通过了安全筛查。每次通过安全筛查都进入 ECMO 撤离试验。在 16 名患者（61.5%）中，有 28 次通过 ECMO 撤离试验（47.5%）。未发生错过安全筛查、方案偏离或不良事件。在通过 ECMO 撤离试验的 16 名患者中，14 名患者（87.5%）拔管。在拔管患者中，12 名患者（85.7%）在通过 ECMO 撤离试验的同一天拔管，6 名患者（42.9%）在第一次通过 ECMO 撤离试验的当天拔管，6 名患者（42.9%）在拔管前至少连续两次通过 ECMO 撤离试验。从第一次通过 ECMO 撤离试验到拔管的中位时间为 2 天（四分位间距，0-3 天）。
解释
ECMO 撤离方案是可行的，可能比逐渐撤机的方法更早地识别出需要拔管的患者。
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