Zhou Hong, Shi Qindong, Guo Litao
Department of Respiratory and Critical Care Medicine The First Affiliated Hospital of Xi'an Jiaotong University Xi'an China.
Department of Critical Care Medicine The First Affiliated Hospital of Xi'an Jiaotong University Xi'an China.
Health Sci Rep. 2023 Jun 16;6(6):e1325. doi: 10.1002/hsr2.1325. eCollection 2023 Jun.
Extracorporeal membrane oxygenation (ECMO) is an important means of treating patients with respiratory failure. Massive airway hemorrhage is a rare complication of ECMO, with high mortality. The aim of this study was to provide a reference for improving the success rate of treatment of this complication by analyzing and summarizing patient clinical data.
We searched PubMed, Medline, and EMBASE databases for case reports of massive airway bleeding associated with ECMO from January 2000 to January 2022 and included one case treated at our facility. All patients were disconnected from the ventilator, and the endotracheal tube was clamped during treatment, resulting in complete airway packing for hemostasis. The clinical data of these patients were analyzed.
Through searching and further screening, two works of literature reported four cases that met our inclusion criteria. Including our patient's case, five patients were included in this study (four adults and one neonate). The longest ECMO treatment time before bleeding was 14 days, and the shortest was 20 min. In all patients, conservative treatment was ineffective after a major airway hemorrhage. They were disconnected from the ventilator and the tracheal tube was clamped for 13-72 h. The four adult patients underwent bronchial artery embolization in the interventional radiology suite. All patients' bleeding stopped after treatment; they were successfully weaned off ECMO and discharged.
Treatment measures to disconnect the ventilator and clamp the endotracheal tube with full support from ECMO are feasible for massive airway bleeding associated with ECMO. Early bronchial arteriography and embolization can prevent rebleeding.
体外膜肺氧合（ECMO）是治疗呼吸衰竭患者的重要手段。大量气道出血是ECMO罕见的并发症，死亡率高。本研究旨在通过分析和总结患者临床资料，为提高该并发症的治疗成功率提供参考。
我们检索了PubMed、Medline和EMBASE数据库，查找2000年1月至2022年1月期间与ECMO相关的大量气道出血的病例报告，并纳入了我院治疗的1例病例。所有患者在治疗期间均脱离呼吸机，气管插管夹闭，实现气道完全填塞止血。对这些患者的临床资料进行分析。
通过检索和进一步筛选，两篇文献报道了4例符合我们纳入标准的病例。包括我院患者的病例在内，本研究共纳入5例患者（4例成人和1例新生儿）。出血前最长的ECMO治疗时间为14天，最短为20分钟。所有患者发生大量气道出血后保守治疗均无效。他们脱离呼吸机，气管插管夹闭13 - 72小时。4例成年患者在介入放射科进行了支气管动脉栓塞术。所有患者治疗后出血停止；成功撤机并出院。
在ECMO全力支持下，脱离呼吸机并夹闭气管插管的治疗措施对于ECMO相关的大量气道出血是可行的。早期支气管动脉造影和栓塞可预防再出血。
