Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock Service, Intergris Baptist Medical Center, Oklahoma City, OK, USA.
Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia.
Int J Artif Organs. 2022 Dec;45(12):1006-1012. doi: 10.1177/03913988221121355. Epub 2022 Sep 9.
The ProtekDuo with oxygenator mimics veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) in veno-pulmonary (V-P) configuration. We have recently developed a new configuration by utilizing a 25 Fr multistage femoral venous drainage cannula and by returning oxygenated blood through both lumina of the double lumen ProtekDuo cannula (V-VP configuration), thereby creating partial right ventricular bypass and oxygenated blood flow of up to seven LPM. We investigated our experience with V-P and V-VP ECMO in patients suffering from COVID-19 acute respiratory distress syndrome (ARDS).
Single center, retrospective observational study.
Of nine patients, one was initiated on V-A, two on V-P, and six on V-V ECMO. All patients were reconfigured to V-P and five patients in addition had V-VP ECMO configuration. All patients had at least one and up to three circuit exchanges. Patients were on ECMO support between 20 and 122 (55 ± 29) days, were in ICU between 46 and 161 (78 ± 40) days with a total hospital length of stay between 35 and 171 (82 ± 42) days. Six of nine (67%) patients could successfully be weaned off ECMO, survived, and were discharged.
The ProtekDuo cannula in V-P configuration provides ECMO blood flow while reducing RV flow, wall-stress and dilatation, as well as oxygen consumption. The V-VP configuration is useful to provide high blood flows of up to seven LPM of oxygenated blood, and partial RV support without over-circulating the pulmonary vascular bed. Our results show that V-P and V-VP ECMO configurations are feasible, have good outcome and are without complications.
带氧合器的 ProtekDuo 在肺静脉（V-P）构型中模拟静脉-静脉（V-V）体外膜肺氧合（ECMO）。我们最近开发了一种新构型，使用 25 Fr 多级股静脉引流插管，并通过双腔 ProtekDuo 插管的两个腔（V-VP 构型）返回充氧血液，从而创建部分右心室旁路和高达 7 LPM 的充氧血流。我们研究了在 COVID-19 急性呼吸窘迫综合征（ARDS）患者中使用 V-P 和 V-VP ECMO 的经验。
单中心回顾性观察研究。
在 9 名患者中，1 名患者开始接受 V-A，2 名患者接受 V-P，6 名患者接受 V-V ECMO。所有患者均重新配置为 V-P，其中 5 名患者另外配置 V-VP ECMO 构型。所有患者均至少进行了一次和最多三次回路更换。患者接受 ECMO 支持的时间为 20 至 122 天（55±29 天），在 ICU 中的时间为 46 至 161 天（78±40 天），总住院时间为 35 至 171 天（82±42 天）。9 名患者中的 6 名（67%）能够成功脱机 ECMO，存活并出院。
在 V-P 构型中，ProtekDuo 插管在降低 RV 流量、壁应力和扩张以及耗氧量的同时提供 ECMO 血流。V-VP 构型可用于提供高达 7 LPM 的充氧血流和部分 RV 支持，而不会过度循环肺血管床。我们的结果表明，V-P 和 V-VP ECMO 构型是可行的，具有良好的结果且无并发症。
