Department of Critical Care of the University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Cardiothoracic Surgery, Section Extracorporeal Circulation of the University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Perfusion. 2024 Jul;39(5):911-920. doi: 10.1177/02676591231168642. Epub 2023 Mar 30.
Despite systemic anticoagulation and antithrombotic surface coating, oxygenator dysfunction remains one of most common technical complications of Extracorporeal membrane oxygenation (ECMO). Several parameters have been associated with an oxygenator exchange, but no guidelines for when to perform an exchange are published. An exchange, especially an emergency exchange, has a risk of complications. Therefore, a delicate balance between oxygenator dysfunction and the exchange of the oxygenator exists. This study aimed to identify risk factors and predictors for elective and emergency oxygenator exchanges.
This observational cohort study included all adult patients supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO). We compared patients' characteristics and laboratory values of patients with and without an oxygenator exchange and between an elective and emergency exchange, defined as an exchange outside office hours. Risk factors for an oxygenator exchange were identified with cox regression analyses, and risk factors for an emergency exchange were identified with logistic regression analyses.
We included forty-five patients in the analyses. There were twenty-nine oxygenator exchanges in nineteen patients (42%). More than a third of the exchanges were emergency exchanges. Higher partial pressure of carbon dioxide (PaCO2), transmembrane pressure difference (ΔP), and hemoglobin (Hb) were associated with an oxygenator exchange. Lower lactate dehydrogenase (LDH) was the only risk factor for an emergency exchange.
Oxygenator exchange is frequent during V-V ECMO support. PaCO2, ΔP and Hb were associated with an oxygenator exchange and lower LDH with the risk of an emergency exchange.
尽管进行了全身抗凝和抗血栓表面涂层处理，氧合器功能障碍仍然是体外膜氧合（ECMO）最常见的技术并发症之一。已经有几个参数与氧合器交换相关，但没有发布关于何时进行交换的指南。交换，特别是紧急交换，存在并发症风险。因此，氧合器功能障碍和氧合器的交换之间存在微妙的平衡。本研究旨在确定择期和紧急更换氧合器的危险因素和预测因素。
本观察性队列研究纳入了所有接受静脉-静脉体外膜氧合（V-V ECMO）支持的成年患者。我们比较了有和没有氧合器交换的患者的特征和实验室值，以及择期和紧急交换（定义为非工作时间的交换）之间的患者。使用 COX 回归分析确定氧合器交换的危险因素，使用逻辑回归分析确定紧急交换的危险因素。
我们分析了 45 名患者。19 名患者中有 29 次氧合器交换（42%）。超过三分之一的交换是紧急交换。较高的二氧化碳分压（PaCO2）、跨膜压力差（ΔP）和血红蛋白（Hb）与氧合器交换相关。较低的乳酸脱氢酶（LDH）是紧急交换的唯一危险因素。
在 V-V ECMO 支持期间，氧合器交换很常见。PaCO2、ΔP 和 Hb 与氧合器交换相关，而 LDH 较低则与紧急交换的风险相关。
