Department of Anatomical Sciences, St. George's University School of Medicine, Grenada.
Department of Internal Medicine, University of Maryland Medical Center MTC, Baltimore, USA.
Thromb Res. 2022 Apr;212:58-71. doi: 10.1016/j.thromres.2022.02.015. Epub 2022 Feb 23.
Extracorporeal membrane oxygenation (ECMO) is a form of prolonged mechanical cardiopulmonary supportive therapy implemented for the survival of patients with refractory cardiac and respiratory dysfunction. Venovenous (VV) and venoarterial (VA) ECMO are both used to buy time in severe respiratory failure while VA ECMO also provides hemodynamic support. Unfortunately, the risk of developing circuit or cannula associated and systemic thrombosis in patients supported by ECMO and post circuit decannulation is a devastating complication, although the relationship between venous thromboembolism (VTE) and ECMO use has not been fully established. Due to the lack of knowledge and literature centered on this topic area, currently there are no official guidelines for prompt diagnosis by screening or to optimize prevention and treatment of VTE in this specific population. This review analyzes the relationship between ECMO and subsequent VTE. We also discuss pertinent prophylactic and therapeutic anticoagulation treatments in patients diagnosed with VTE while on ECMO along with the obstacles associated with them.
体外膜肺氧合（ECMO）是一种延长的机械心肺支持治疗方法，用于治疗难治性心脏和呼吸功能障碍患者的生存。静脉-静脉（VV）和静脉-动脉（VA）ECMO 均可用于在严重呼吸衰竭时争取时间，而 VA ECMO 还提供血液动力学支持。不幸的是，在 ECMO 支持的患者中，以及在导管拆除后，发生与回路或导管相关的和全身性血栓形成的风险是一种毁灭性的并发症，尽管 ECMO 使用与静脉血栓栓塞症（VTE）之间的关系尚未完全确立。由于缺乏关于这一专题领域的知识和文献，目前没有针对该特定人群进行 VTE 筛查以进行快速诊断或优化预防和治疗 VTE 的正式指南。本综述分析了 ECMO 与随后发生的 VTE 之间的关系。我们还讨论了在 ECMO 治疗期间诊断为 VTE 的患者的相关预防性和治疗性抗凝治疗，以及与这些治疗相关的障碍。
