Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA.
General Surgery, Naval Hospital Bremerton, Bremerton, WA, USA.
Perfusion. 2022 Oct;37(7):752-756. doi: 10.1177/02676591211030767. Epub 2021 Jul 15.
Complications associated with use of dual-lumen venovenous extracorporeal membrane oxygenation (VV-ECMO) cannulas are of concern in pediatric patients. While the risk of atrial perforation is believed to be higher with bicaval cannulas, direct comparison of complication rate between atrial and bicaval cannulas has not been conducted in this population.
A retrospective review was conducted at a free-standing children's hospital of all patients 0-18 years old, placed on VV-ECMO with a dual-lumen cannula from January 2009 to December 2018. Patients were grouped based on cannula type. Complications were assessed over the entire duration of the ECMO run. Logistic regression analyses were used to evaluate for an association between cannula type and risk of pericardial effusion or cannula-related complication requiring median sternotomy or pericardial drain placement.
During the study period 119 patients were placed on VVECMO using a dual-lumen cannula. Eighty-two patients (69%) were <2 years old, 19 (16%) were 2-10 years old, and 18 (15%) were 11-18 years old. Seventy-three were cannulated with an atrial cannula and 46 patients received a bicaval cannula. Pericardial effusions were seen in 30% and 24% of these patients respectively while severe complications were seen in 9.6% and 8.7% of patients respectively. Compared to patients treated with a bicaval cannula, those who received an atrial cannula had similar odds of effusions (OR: 1.41, 95% CI: 0.62-3.36) and severe complications (OR 0.89, 95% CI: 0.27-3.18). After adjusting for age, weight, cannula and circuit manipulations, and use of echocardiography, the OR of effusion was 1.91 (95% CI: 0.65-6.42), and the adjusted OR of severe complication was 0.69 (95% CI: 0.16-3.33).
There were no significant differences in frequency of pericardial effusions or severe cannula-related complications between the treatment groups across all pediatric patients and within the subgroup of patients under 2 years of age.
与使用双腔静脉-静脉体外膜肺氧合（VV-ECMO）插管相关的并发症是儿科患者关注的问题。虽然人们认为使用双腔插管会增加心房穿孔的风险，但尚未在该人群中对心房插管和双腔插管之间的并发症发生率进行直接比较。
对一家独立的儿童医院从 2009 年 1 月至 2018 年 12 月期间使用双腔插管接受 VV-ECMO 的 0-18 岁患者进行回顾性研究。根据插管类型对患者进行分组。评估整个 ECMO 运行期间的并发症。使用逻辑回归分析评估插管类型与心包积液或需要正中开胸或心包引流放置的插管相关并发症风险之间的关联。
在研究期间，有 119 名患者使用双腔插管接受 VV-ECMO。82 名患者（69%）<2 岁，19 名患者（16%）2-10 岁，18 名患者（15%）11-18 岁。73 名患者使用心房插管，46 名患者使用双腔插管。分别有 30%和 24%的患者出现心包积液，分别有 9.6%和 8.7%的患者出现严重并发症。与接受双腔插管的患者相比，接受心房插管的患者心包积液的发生几率相似（OR：1.41，95%CI：0.62-3.36），严重并发症的发生几率也相似（OR：0.89，95%CI：0.27-3.18）。调整年龄、体重、插管和回路操作以及使用超声心动图后，积液的 OR 为 1.91（95%CI：0.65-6.42），严重并发症的调整 OR 为 0.69（95%CI：0.16-3.33）。
在所有儿科患者和<2 岁患者亚组中，治疗组之间心包积液或严重插管相关并发症的发生率无显著差异。
