Cardiothoracic Intensive Care Unit, Hôpital Marie LannelongueGroupe Hospitalier Paris Saint Joseph, 133 Avenue de La Résistance, 92350, Le Plessis-Robinson, France.
Department of Anesthesiology, Extracorporeal Circulation Referral Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France.
Crit Care. 2023 Jun 2;27(1):219. doi: 10.1186/s13054-023-04503-9.
Bleeding and thrombosis induce major morbidity and mortality in patients under extracorporeal membrane oxygenator (ECMO). Circuit changes can be performed for oxygenation membrane thrombosis but are not recommended for bleeding under ECMO. The objective of this study was to evaluate the course of clinical, laboratory, and transfusion parameters before and after ECMO circuit changes warranted by bleeding or thrombosis.
In this single-center, retrospective, cohort study, clinical parameters (bleeding syndrome, hemostatic procedures, oxygenation parameters, transfusion) and laboratory parameters (platelet count, hemoglobin, fibrinogen, PaO) were collected over the seven days surrounding the circuit change.
In the 274 patients on ECMO from January 2017 to August 2020, 48 circuit changes were performed in 44 patients, including 32 for bleeding and 16 for thrombosis. Mortality was similar in the patients with vs. without changes (21/44, 48% vs. 100/230, 43%) and in those with bleeding vs. thrombosis (12/28, 43% vs. 9/16, 56%, P = 0.39). In patients with bleeding, numbers of bleeding events, hemostatic procedures, and red blood cell transfusions were significantly higher before vs. after the change (P < 0.001); the platelet counts and fibrinogen levels decreased progressively before and increased significantly after the change. In patients with thrombosis, numbers of bleeding events and red blood cell transfusions did not change after membrane change. No significant differences were demonstrated between oxygenation parameters (ventilator FiO, ECMO FiO, and PaO) and ECMO flow before vs. after the change.
In patients with severe and persistent bleeding, changing the ECMO circuit decreased clinical bleeding and red blood cell transfusion needs and increased platelets and fibrinogen levels. Oxygenation parameters did not change significantly in the group with thrombosis.
在体外膜肺氧合（ECMO）患者中，出血和血栓形成会导致严重的发病率和死亡率。可以对氧合膜进行血栓形成的回路变化，但不建议在 ECMO 下出血时进行。本研究的目的是评估出血或血栓形成需要 ECMO 回路变化前后的临床、实验室和输血参数的过程。
在这项单中心、回顾性队列研究中，在 ECMO 上的 274 例患者中，在 ECMO 回路变化前后的七天内收集了临床参数（出血综合征、止血程序、氧合参数、输血）和实验室参数（血小板计数、血红蛋白、纤维蛋白原、PaO）。
在 2017 年 1 月至 2020 年 8 月期间接受 ECMO 的 44 名患者中，有 48 次回路变化，包括 32 次出血和 16 次血栓形成。有变化和无变化的患者死亡率相似（21/44，48%对 100/230，43%），出血和血栓形成的患者死亡率也相似（12/28，43%对 9/16，56%，P=0.39）。在出血的患者中，出血事件、止血程序和红细胞输血的数量在变化前明显高于变化后（P<0.001）；血小板计数和纤维蛋白原水平在变化前逐渐下降，变化后显著增加。在血栓形成的患者中，膜变化后出血事件和红细胞输血的数量没有变化。在氧合参数（呼吸机 FiO、ECMO FiO 和 PaO）和变化前后的 ECMO 流量之间没有显示出显著差异。
在严重和持续出血的患者中，改变 ECMO 回路降低了临床出血和红细胞输血的需求，并增加了血小板和纤维蛋白原水平。在血栓形成的组中，氧合参数没有发生显著变化。
Zotero 插件