From the Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
ASAIO J. 2021 Dec 1;67(12):1294-1300. doi: 10.1097/MAT.0000000000001507.
Placement of extracorporeal membrane oxygenation (ECMO) in obese patients has been challenging; however, cannulation risk in obese patients has not been clearly investigated. We therefore explored ECMO cannulation complications in this obese population. Data were reviewed from adult ECMO database from 2010 to 2019. Patients were stratified by body mass index (BMI) (normal weight [NW] [BMI 18.5-24.9], overweight [BMI 25-29.9], class I [BMI 30-34.9], class II [BMI 35-39.9], class III [BMI >40]). Patients with central cannulation were excluded from this study. Combined ECMO cannulation complications and survival data were retrospectively analyzed. There were 233 patients, 156 venoarterial (VA) ECMO patients (45 [28%] NW, 51 [33%] overweight, 37 [24%] class I, 12 [8%] class II, and 11 [7.0%] class III) and 77 venovenous (VV) ECMO patients (14 [18%] NW, 13 [17%] overweight, 17 [22%] class I, 11 [14%] class II, and 22 [29%] class III). There were significantly more cannulation site bleeds in VA class III (55%) patients compared with VA NW patients (22%), p = 0.006. There was no significant difference in cannulation site bleeding between BMI groups for VV ECMO. There was no difference in 30 day mortality, ECMO survival for all BMI groups in both VA and VV ECMO. There is significant increased risk of bleeding with peripheral VA cannulation of obese patients with BMI > 35. Cannulating surgeon should be aware of this bleeding risk in morbidly obese patient who undergo VA ECMO.
体外膜肺氧合（ECMO）在肥胖患者中的应用一直具有挑战性；然而，肥胖患者的置管风险尚未得到明确研究。因此，我们在肥胖人群中探讨了 ECMO 置管并发症。从 2010 年至 2019 年回顾了成人 ECMO 数据库中的数据。患者根据体重指数（BMI）进行分层（正常体重[NW] [BMI 18.5-24.9]，超重[BMI 25-29.9]，I 类[BMI 30-34.9]，II 类[BMI 35-39.9]，III 类[BMI>40]）。本研究排除了中心置管的患者。回顾性分析了合并 ECMO 置管并发症和生存数据。共有 233 例患者，其中 156 例行静脉-动脉（VA）ECMO（45 例[28%]为 NW，51 例[33%]为超重，37 例[24%]为 I 类，12 例[8%]为 II 类，11 例[7.0%]为 III 类）和 77 例行静脉-静脉（VV）ECMO（14 例[18%]为 NW，13 例[17%]为超重，17 例[22%]为 I 类，11 例[14%]为 II 类，22 例[29%]为 III 类）。与 VA NW 患者（22%）相比，VA III 类（55%）患者的置管部位出血明显更多，p = 0.006。VV ECMO 中，BMI 组之间的置管部位出血无显著差异。VA 和 VV ECMO 中，所有 BMI 组的 30 天死亡率和 ECMO 生存率均无差异。对于 BMI>35 的肥胖患者，VA 外周置管的出血风险显著增加。进行 VA ECMO 的病态肥胖患者，置管外科医生应注意到这种出血风险。
