Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA.
Crit Care Med. 2023 Jul 1;51(7):e140-e144. doi: 10.1097/CCM.0000000000005860. Epub 2023 Mar 16.
There has been a sustained increase in the utilization of venovenous extracorporeal membrane oxygenation (ECMO) over the last decade, further exacerbated by the COVID-19 pandemic. We set out to describe our institutional experience with extremely prolonged (> 50 d) venovenous ECMO support for recovery or bridge to lung transplant candidacy in patients with acute respiratory failure.
Retrospective cohort study.
A large tertiary urban care center.
Patients 18 years or older receiving venovenous ECMO support for greater than 50 days, with initial cannulation between January 2018 and January 2022.
None.
One hundred thirty patients were placed on venovenous ECMO during the study period. Of these, 12 received prolonged (> 50 d) venovenous ECMO support. Eleven patients (92%) suffered from adult respiratory distress syndrome (ARDS) secondary to COVID-19, while one patient with prior bilateral lung transplant suffered from ARDS secondary to bacterial pneumonia. The median age of patients was 39 years (interquartile range [IQR], 35-51 yr). The median duration of venovenous ECMO support was 94 days (IQR, 70-128 d), with a maximum of 180 days. Median time from intubation to cannulation was 5 days (IQR, 2-14 d). Nine patients (75%) were successfully mobilized while on venovenous ECMO support. Successful weaning of venovenous ECMO support occurred in eight patients (67%); 6 (50%) were bridged to lung transplantation and 2 (17%) were bridged to recovery. Of those successfully weaned, seven patients (88%) were discharged from the hospital. All seven patients discharged from the hospital were alive 6 months post-decannulation; 83% (5/6) with sufficient follow-up time were alive 1-year after decannulation.
Our experience suggests that extremely prolonged venovenous ECMO support to allow native lung recovery or optimization for lung transplantation may be a feasible strategy in select critically ill patients, further supporting the expanded utilization of venovenous ECMO for refractory respiratory failure.
在过去十年中，静脉-静脉体外膜肺氧合（ECMO）的应用持续增加，COVID-19 大流行进一步加剧了这种情况。我们旨在描述我们在急性呼吸衰竭患者中使用静脉-静脉 ECMO 进行极长时间（>50 天）支持以恢复或桥接至肺移植候选资格的机构经验。
回顾性队列研究。
大型三级城市护理中心。
2018 年 1 月至 2022 年 1 月期间接受静脉-静脉 ECMO 支持超过 50 天且初始置管的年龄在 18 岁或以上的患者。
无。
在研究期间，有 130 名患者接受静脉-静脉 ECMO 治疗。其中 12 名患者接受了长时间（>50 天）静脉-静脉 ECMO 支持。11 名患者（92%）患有 COVID-19 引起的成人呼吸窘迫综合征（ARDS），而一名有双侧肺移植史的患者患有细菌性肺炎引起的 ARDS。患者的中位年龄为 39 岁（四分位距 [IQR]，35-51 岁）。静脉-静脉 ECMO 支持的中位时间为 94 天（IQR，70-128 天），最长达 180 天。从插管到置管的中位时间为 5 天（IQR，2-14 天）。9 名患者（75%）在接受静脉-静脉 ECMO 支持时成功移动。8 名患者（67%）成功撤机；6 名（50%）桥接至肺移植，2 名（17%）桥接至恢复。在成功撤机的患者中，7 名患者（88%）出院。出院的 7 名患者在撤管后 6 个月时均存活；83%（5/6）有足够随访时间的患者在撤管后 1 年时存活。
我们的经验表明，在选择的危重患者中，使用极长时间的静脉-静脉 ECMO 支持以允许原生肺恢复或优化肺移植可能是一种可行的策略，进一步支持静脉-静脉 ECMO 用于难治性呼吸衰竭的扩展应用。
