Fisser Christoph, Palmér Oscar, Sallisalmi Marko, Paulus Michael, Foltan Maik, Philipp Alois, Malfertheiner Maximilian V, Lubnow Matthias, Müller Thomas, Broman Lars Mikael
Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.
ECMO Centre Karolinska, Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
Front Med (Lausanne). 2022 Aug 31;9:973240. doi: 10.3389/fmed.2022.973240. eCollection 2022.
Recirculation is a common problem in venovenous (VV) extracorporeal membrane oxygenation (ECMO). The aims of this study were to compare recirculation fraction (R) between femoro-jugular and jugulo-femoral VV ECMO configurations, to identify risk factors for recirculation and to assess the impact on hemolysis.
Patients in the medical intensive care unit (ICU) at the University Medical Center Regensburg, Germany receiving VV ECMO with femoro-jugular, and jugulo-femoral configuration at the ECMO Center Karolinska, Sweden, were included in this non-randomized prospective study. Total ECMO flow ( ), recirculated flow (Q), and recirculation fraction R = Q/Q were determined using ultrasound dilution technology. Effective ECMO flow (Q) was defined as Q = Q * (1-R). Demographics, cannula specifics, and markers of hemolysis were assessed. Survival was evaluated at discharge from ICU.
Thirty-seven patients with femoro-jugular configuration underwent 595 single-point measurements and 18 patients with jugulo-femoral configuration 231 measurements. R was lower with femoro-jugular compared to jugulo-femoral configuration [5 (0, 11) vs. 19 (13, 28) %, respectively ( < 0.001)], resulting in similar Q [2.80 (2.21, 3.39) vs. 2.79 (2.39, 3.08) L/min ( = 0.225)] despite lower Q with femoro-jugular configuration compared to jugulo-femoral [3.01 (2.40, 3.70) vs. 3.57 (3.05, 4.06) L/min, respectively ( < 0.001)]. In multivariate regression analysis, the type of configuration, distance between the two cannula tips, ECMO flow, and heart rate were significantly associated with Rf [B (95% CI): 25.8 (17.6, 33.8), p < 0.001; 960.4 (960.7, 960.1), = 0.009; 4.2 (2.5, 5.9), p < 0.001; 960.1 (960.2, 0.0), p = 0.027]. Hemolysis was similar in subjects with Rf > 8 vs. ≤ 8%. Explorative data on survival showed comparable results in the femoro-jugular and the jugulo-femoral group (81 vs. 72%, = 0.455).
VV ECMO with femoro-jugular configuration caused less recirculation. Further risk factors for higher R were shorter distance between the two cannula tips, higher ECMO flow, and lower heart rate. R did not affect hemolysis.
再循环是静脉-静脉（VV）体外膜肺氧合（ECMO）中的常见问题。本研究的目的是比较股-颈和颈-股VV ECMO配置之间的再循环分数（R），确定再循环的危险因素，并评估其对溶血的影响。
德国雷根斯堡大学医学中心重症监护病房（ICU）接受股-颈和颈-股配置VV ECMO的患者，以及瑞典卡罗林斯卡ECMO中心的患者，纳入了这项非随机前瞻性研究。使用超声稀释技术测定总ECMO流量（ ）、再循环流量（Q）和再循环分数R = Q/Q。有效ECMO流量（Q）定义为Q = Q * (1 - R)。评估人口统计学、插管细节和溶血标志物。在ICU出院时评估生存率。
37例采用股-颈配置的患者进行了595次单点测量，18例采用颈-股配置的患者进行了231次测量。与颈-股配置相比，股-颈配置的R较低[分别为5（0，11）%和19（13，28）%（ < 0.001）]，尽管股-颈配置的Q低于颈-股配置[分别为3.01（2.40，3.70）L/min和3.57（3.05，4.06）L/min（ < 0.001）]，但有效ECMO流量（Q）相似[2.80（2.21，3.39）L/min和2.79（2.39，3.08）L/min（ = 0.225）]。在多变量回归分析中，配置类型、两个插管尖端之间的距离、ECMO流量和心率与Rf显著相关[B（95%CI）：25.8（17.6，33.8），p < 0.001；960.4（960.7，960.1）， = 0.009；4.2（2.5，5.9），p < 0.001；960.1（960.2，0.0），p = 0.027]。Rf > 8%与≤8%的受试者溶血情况相似。关于生存率的探索性数据显示，股-颈组和颈-股组的结果相当（81%对72%， = 0.455）。
采用股-颈配置的VV ECMO再循环较少。R升高的其他危险因素是两个插管尖端之间的距离较短、ECMO流量较高和心率较低。R不影响溶血。
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