From the Department of Medicine, Jewish General Hospital, McGill University, Montréal, Quebec.
Department of Anesthesia, Division of Critical Care, McGill University, Jewish General Hospital, Montréal, Quebec.
ASAIO J. 2022 Dec 1;68(12):1523-1528. doi: 10.1097/MAT.0000000000001694. Epub 2022 Mar 19.
Extracorporeal membrane oxygenation (ECMO) has become an increasingly used tool for cardiorespiratory support. Thrombosis is a well-recognized complication of ECMO, yet the burden of disease remains unclear. We undertook a systematic review to investigate the incidence of venous thromboembolism (VTE) during ECMO or soon after decannulation, in patients screened for VTE. We retrieved all studies that evaluated VTE incidence in ECMO patients in EMBASE, MEDLINE, Web of Science, and Cochrane Library from inception to April 2, 2021. Studies reporting incidence of VTE diagnosed on systematic screening tests during ECMO or within 7 days of decannulation in adult patients were included. A total of 18 studies were included in the systematic review. These studies screened a total of 1095 ECMO patients. Most studies screened for cannula-associated deep vein thrombosis (CaDVT) after decannulation. The overall incidence of DVT was 52.8% (95% CI, 49.8-55.8%). Incidence of DVT was 53.5% (95% CI, 50.0-57.0%) for venovenous ECMO vs. 34.0% (95% CI, 26.5-42.2%) for venoarterial ECMO. No studies screened for pulmonary embolism. Our systematic review found a very high incidence of DVT among patients treated with ECMO. Routine screening for DVT after decannulation for all ECMO patients may be warranted.
体外膜肺氧合（ECMO）已成为心肺支持的一种越来越常用的工具。血栓形成是 ECMO 的一种公认并发症，但疾病负担仍不清楚。我们进行了一项系统评价，以调查接受 VTE 筛查的 ECMO 患者在 ECMO 期间或脱机后不久静脉血栓栓塞症（VTE）的发生率。我们在 EMBASE、MEDLINE、Web of Science 和 Cochrane Library 中检索了截至 2021 年 4 月 2 日评估 ECMO 患者 VTE 发生率的所有研究。纳入了报告在 ECMO 期间或脱机后 7 天内通过系统筛查试验诊断 VTE 发生率的成人患者的研究。系统评价共纳入 18 项研究。这些研究共筛查了 1095 例 ECMO 患者。大多数研究在脱机后筛查与导管相关的深静脉血栓形成（CaDVT）。DVT 的总体发生率为 52.8%（95%CI，49.8-55.8%）。静脉-静脉 ECMO 的 DVT 发生率为 53.5%（95%CI，50.0-57.0%），而静脉-动脉 ECMO 的 DVT 发生率为 34.0%（95%CI，26.5-42.2%）。没有研究筛查肺栓塞。我们的系统评价发现接受 ECMO 治疗的患者 DVT 发生率非常高。可能需要对所有 ECMO 患者在脱机后常规筛查 DVT。
