Teijeiro-Paradis Ricardo, Gannon Whitney D, Fan Eddy
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
Crit Care Med. 2022 Dec 1;50(12):1809-1818. doi: 10.1097/CCM.0000000000005673. Epub 2022 Sep 12.
Despite increasing use and promising outcomes, venovenous extracorporeal membrane oxygenation (V-V ECMO) introduces the risk of a number of complications across the spectrum of ECMO care. This narrative review describes the variety of short- and long-term complications that can occur during treatment with ECMO and how patient selection and management decisions may influence the risk of these complications.
English language articles were identified in PubMed using phrases related to V-V ECMO, acute respiratory distress syndrome, severe respiratory failure, and complications.
Original research, review articles, commentaries, and published guidelines from the Extracorporeal Life support Organization were considered.
Data from relevant literature were identified, reviewed, and integrated into a concise narrative review.
Selecting patients for V-V ECMO exposes the patient to a number of complications. Adequate knowledge of these risks is needed to weigh them against the anticipated benefit of treatment. Timing of ECMO initiation and transfer to centers capable of providing ECMO affect patient outcomes. Choosing a configuration that insufficiently addresses the patient's physiologic deficit leads to consequences of inadequate physiologic support. Suboptimal mechanical ventilator management during ECMO may lead to worsening lung injury, delayed lung recovery, or ventilator-associated pneumonia. Premature decannulation from ECMO as lungs recover can lead to clinical worsening, and delayed decannulation can prolong exposure to complications unnecessarily. Short-term complications include bleeding, thrombosis, and hemolysis, renal and neurologic injury, concomitant infections, and technical and mechanical problems. Long-term complications reflect the physical, functional, and neurologic sequelae of critical illness. ECMO can introduce ethical and emotional challenges, particularly when bridging strategies fail.
V-V ECMO is associated with a number of complications. ECMO selection, timing of initiation, and management decisions impact the presence and severity of these potential harms.
尽管静脉-静脉体外膜肺氧合（V-V ECMO）的应用日益广泛且疗效可观，但在整个ECMO治疗过程中会引发多种并发症风险。本叙述性综述描述了ECMO治疗期间可能出现的各种短期和长期并发症，以及患者选择和管理决策如何影响这些并发症的风险。
在PubMed中使用与V-V ECMO、急性呼吸窘迫综合征、严重呼吸衰竭和并发症相关的短语检索英文文章。
考虑了原始研究、综述文章、评论以及体外生命支持组织发布的指南。
识别、审查相关文献中的数据，并将其整合为一篇简明的叙述性综述。
选择接受V-V ECMO治疗的患者会使其面临多种并发症。需要充分了解这些风险，以便将其与预期的治疗益处进行权衡。ECMO启动的时机以及转至能够提供ECMO治疗的中心会影响患者的治疗结果。选择一种无法充分解决患者生理缺陷的配置会导致生理支持不足的后果。ECMO期间机械通气管理欠佳可能导致肺损伤加重、肺恢复延迟或呼吸机相关性肺炎。随着肺部恢复而过早拔除ECMO导管可能导致临床病情恶化，而延迟拔管则可能不必要地延长并发症暴露时间。短期并发症包括出血、血栓形成、溶血、肾和神经损伤、并发感染以及技术和机械问题。长期并发症反映了危重病的身体、功能和神经后遗症。ECMO可能带来伦理和情感挑战，尤其是在桥接策略失败时。
V-V ECMO与多种并发症相关。ECMO的选择、启动时机和管理决策会影响这些潜在危害的存在和严重程度。
