Thiara Sonny, Serpa Neto Ary, Burrell Aidan J C, Fulcher Bentley J, Hodgson Carol L
Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Australian and New Zealand Intensive Care-Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Crit Care Explor. 2022 May 2;4(5):e0689. doi: 10.1097/CCE.0000000000000689. eCollection 2022 May.
Although the criteria for initiation of venovenous extracorporeal membrane oxygenation (VV ECMO) are well defined, the criteria and timing for VV ECMO decannulation are less certain. The aim of this study was to describe the ventilation and physiologic factors at the time of VV ECMO decannulation and to determine if these factors have association with mechanical ventilation or ICU length of stay after ECMO decannulation.
Multicenter, prospective cohort study.
Eleven ICUs in Australia.
Adult patients treated with VV ECMO from March 19, 2019, to September 20, 2020.
Liberation from VV ECMO.
Of 87 patients receiving VV ECMO, the median age was 49 years (interquartile range, 37-59 yr), 61 of 87 (70%) were male, and 52/87 (60%) had a diagnosis of acute respiratory distress syndrome. There were 24 of 87 patients (28%) who died prior to day 90. No patient required a second run of VV ECMO. In a multivariate models, a higher partial pressure of arterial carbon dioxide ( < 0.01) and respiratory rate at the time of decannulation ( = 0.01) were predictive of a longer duration of mechanical ventilation and ICU length of stay postdecannulation in survivors. Higher positive end-expiratory pressure at ECMO decannulation was associated with shorter duration of ICU length of stay post-ECMO decannulation in survivors ( = 0.01).
A higher partial pressure of arterial carbon dioxide and higher respiratory rate at ECMO decannulation were associated with increased duration of mechanical ventilation and increased duration of ICU stay postdecannulation, and increased positive end-expiratory pressure at decannulation was associated with decreased duration of ICU stay postdecannulation. Future research should further investigate these associations to establish the optimal ventilator settings and timing of liberation from VV ECMO.
尽管启动静脉-静脉体外膜肺氧合（VV ECMO）的标准已明确界定，但VV ECMO拔管的标准和时机尚不确定。本研究的目的是描述VV ECMO拔管时的通气和生理因素，并确定这些因素与拔管后机械通气或重症监护病房（ICU）住院时间是否相关。
多中心前瞻性队列研究。
澳大利亚的11个ICU。
2019年3月19日至2020年9月20日接受VV ECMO治疗的成年患者。
从VV ECMO撤机。
87例接受VV ECMO治疗的患者中，中位年龄为49岁（四分位间距，37 - 59岁），87例中有61例（70%）为男性，87例中有52例（60%）诊断为急性呼吸窘迫综合征。87例患者中有24例（28%）在90天前死亡。没有患者需要再次进行VV ECMO治疗。在多变量模型中，较高的动脉血二氧化碳分压（<0.01）和拔管时的呼吸频率（=0.01）可预测幸存者拔管后机械通气时间和ICU住院时间延长。ECMO拔管时较高的呼气末正压与幸存者ECMO拔管后ICU住院时间缩短相关（=0.01）。
ECMO拔管时较高的动脉血二氧化碳分压和较高的呼吸频率与机械通气时间延长和拔管后ICU住院时间延长相关，而拔管时较高的呼气末正压与拔管后ICU住院时间缩短相关。未来的研究应进一步探究这些关联，以确定最佳的呼吸机设置和从VV ECMO撤机的时机。
