Department of Intensive Care Unit, Binhaiwan Central Hospital of Dongguan, Dongguan City, Guangdong Province, China.
Department of Ultrasound, Binhaiwan Central Hospital of Dongguan, Dongguan City, Guangdong Province, China.
Medicine (Baltimore). 2022 Jul 15;101(28):e29489. doi: 10.1097/MD.0000000000029489.
We aimed to evaluate associated factors for point-of-care ultrasound (POCUS)-guided percutaneous catheterization for venoarterial extracorporeal membrane oxygenation (VA-ECMO). VA-ECMO cases from March 2018 to October 2020 in Department of Intensive Care Unit, Binhaiwan Central Hospital of Dongguan, were enrolled. Clinical data, outcomes, and complications were recorded and summarized. Fifty-nine cases were enrolled, among which 88.1% succeeded in POCUS-guided catheterization via Seldinger technique, whereas 59.3% succeeded at the first puncture. Results showed that artery diameter and times of arterial punctures were independent associated factors for Seldinger puncture (P = .018, odds ratio [OR] = 23.374, 95% confidence interval [CI] = 1.706-320.270; P = .031, OR = 145.098, 95% CI = 1.592-13220.980), and artery diameter and cardiac ejection fraction value (≥30%/<30%) were independent associated factors for first puncture (P = .044, OR = 1.622, 95% CI = 1.014-2.596; P = .013, OR = 5.565, 95% CI = 1.441-21.488). For extracorporeal cardiopulmonary resuscitation patients, artery diameter was independent associated factor for Seldinger puncture (P = .022, OR = 2.070, 95% CI = 1.110-3.858), and cardiac ejection fraction value (≥30%/<30%) was independent associated factor for first puncture (P = .007, OR = 9.533, 95% CI = 1.847-49.204). Thirteen patients (22.0%) had local hemorrhage post puncture, 8 patients (13.6%) presented distal limb arterial ischemia, and 8 patients (13.6%) suffered puncture-related thrombosis. Vasoactive Inotropic Score was found to be independent associated factor for local hemorrhage (P = .039, OR = 0.994, 95% CI = 0.988-1.000), and the Acute Physiology and Chronic Health Evaluation II score was independent associated factor for thrombosis (P = .025, OR = 0.935, 95% CI = 0.882-0.992). Diabetes and cardiopulmonary resuscitation time before catheterization were independent factors for distal limb ischemia (P = .026, OR = 220.774, 95% CI = 1.905-25591.327; P = .017, OR = 1.054, 95% CI = 1.009-1.101). POCUS-guided percutaneous catheterization via Seldinger technique can be the first choice for VA-ECMO cannulation, especially for a team without angiotomy qualifications. Before cannulation, evaluating the target artery and heart function by ultrasound can help predict outcome of catheterization. Assessing risk factors (diabetes, cardiopulmonary resuscitation time before catheterization, Vasoactive Inotropic Score, the Acute Physiology and Chronic Health Evaluation II score) is helpful for prevention and treatment of complications.
我们旨在评估床旁超声（POCUS）引导下经皮动静脉体外膜肺氧合（VA-ECMO）置管的相关因素。纳入 2018 年 3 月至 2020 年 10 月在东莞滨海湾中心医院重症监护病房进行的 VA-ECMO 病例。记录并总结临床数据、结局和并发症。共纳入 59 例患者，其中 88.1%通过 Seldinger 技术成功进行了 POCUS 引导下的导管插入，而 59.3%在第一次穿刺时成功。结果表明，动脉直径和动脉穿刺次数是 Seldinger 穿刺的独立相关因素（P=0.018，优势比[OR] = 23.374，95%置信区间[CI] = 1.706-320.270；P=0.031，OR = 145.098，95%CI = 1.592-13220.980），而动脉直径和心脏射血分数值（≥30%/<30%）是第一次穿刺的独立相关因素（P=0.044，OR = 1.622，95%CI = 1.014-2.596；P=0.013，OR = 5.565，95%CI = 1.441-21.488）。对于体外心肺复苏患者，动脉直径是 Seldinger 穿刺的独立相关因素（P=0.022，OR = 2.070，95%CI = 1.110-3.858），而心脏射血分数值（≥30%/<30%）是第一次穿刺的独立相关因素（P=0.007，OR = 9.533，95%CI = 1.847-49.204）。13 例（22.0%）患者穿刺后出现局部出血，8 例（13.6%）患者出现远端肢体动脉缺血，8 例（13.6%）患者发生穿刺相关血栓形成。血管活性正性肌力评分是局部出血的独立相关因素（P=0.039，OR = 0.994，95%CI = 0.988-1.000），急性生理学和慢性健康评估 II 评分是血栓形成的独立相关因素（P=0.025，OR = 0.935，95%CI = 0.882-0.992）。糖尿病和导管置入前心肺复苏时间是远端肢体缺血的独立因素（P=0.026，OR = 220.774，95%CI = 1.905-25591.327；P=0.017，OR = 1.054，95%CI = 1.009-1.101）。POCUS 引导下经皮 Seldinger 技术可作为 VA-ECMO 置管的首选方法，特别是对于没有血管切开术资格的团队。置管前，通过超声评估目标动脉和心脏功能有助于预测置管结果。评估危险因素（糖尿病、导管置入前心肺复苏时间、血管活性正性肌力评分、急性生理学和慢性健康评估 II 评分）有助于预防和治疗并发症。
