Falk Lars, Hultman Jan, Broman Lars M
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
ECMO Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
Perfusion. 2023 May;38(4):818-825. doi: 10.1177/02676591221090667. Epub 2022 May 11.
Differential hypoxemia (DH) has been recognized as a clinical problem during veno-arterial extracorporeal membrane oxygenation (VA ECMO) although its features and consequences have not been fully elucidated. This single center retrospective study aimed to investigate the clinical characteristics of patients manifesting DH as well as the impact of repositioning the drainage point from the inferior vena cava (IVC) to the superior vena cava to alleviate DH. All patients (>15 years) commenced on VA ECMO at our center between 2009 and 2020 were screened. Of 472 eligible patients seven were identified with severe DH. All patients had the drainage cannula tip in the IVC or at the junction between the IVC and right atrium. The mean peripheral capillary saturation increased from 54 (±6.6) to 86 (±6.6) %, ( = <0.001) after repositioning of the cannula. Pre-oxygenator saturation increased from 62 (±8.9) % prior to adjustment to 74 (±3.7) %, ( = 0.016) after repositioning. Plasma lactate tended to decrease within 24 h after adjustment. Five patients (71%) survived ECMO treatment, to discharge from hospital, and were alive at 1-year follow-up. Although DH has been described in several studies, the condition has not been investigated in a clinical setting comparing the effect on upper body saturation before and after repositioning of the drainage cannula. This study shows that moving the drainage zone into the upper part of the body has a marked positive effect on upper body saturation in patients with DH.
尽管差异低氧血症（DH）的特征和后果尚未完全阐明，但它已被公认为是静脉-动脉体外膜肺氧合（VA ECMO）期间的一个临床问题。这项单中心回顾性研究旨在调查表现为DH的患者的临床特征，以及将引流点从下腔静脉（IVC）重新定位到上腔静脉以缓解DH的影响。对2009年至2020年期间在我们中心开始接受VA ECMO治疗的所有患者（>15岁）进行了筛查。在472例符合条件的患者中，有7例被确定为严重DH。所有患者的引流套管尖端均位于IVC或IVC与右心房的交界处。重新定位套管后，平均外周毛细血管饱和度从54（±6.6）%增加到86（±6.6）%，（P< = 0.001）。预充氧器饱和度从调整前的62（±8.9）%增加到重新定位后的74（±3.7）%，（P = 0.016）。调整后24小时内血浆乳酸有下降趋势。5例患者（71%）在ECMO治疗后存活并出院，在1年随访时仍存活。尽管在几项研究中都描述过DH，但尚未在临床环境中对引流套管重新定位前后对上半身饱和度的影响进行研究。这项研究表明，将引流区域移至身体上部对DH患者的上半身饱和度有显著的积极影响。
