Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Mekelle University College of Health Sciences, Mekelle, Ethiopia.
Chest. 2023 Nov;164(5):1184-1203. doi: 10.1016/j.chest.2023.06.018. Epub 2023 Jun 21.
Safe and timely liberation from venovenous extracorporeal membrane oxygenation (ECMO) would be expected to reduce the duration of ECMO, the risk of complications, and costs. However, how to liberate patients from venovenous ECMO effectively remains understudied.
What is the current state of the evidence on liberation from venovenous ECMO?
We systematically searched for relevant publications on liberation from venovenous ECMO in Medline and EMBASE. Citations were included if the manuscripts provided any of the following: criteria for readiness for liberation, a liberation protocol, or a definition of successful decannulation or decannulation failure. We included randomized trials, observational trials, narrative reviews, guidelines, editorials, and commentaries. We excluded single case reports and citations where the full text was unavailable.
We screened 1,467 citations to identify 39 key publications on liberation from venovenous ECMO. We then summarized the data into five main topics: current strategies used for liberation, criteria used to define readiness for liberation, conducting liberation trials, criteria used to proceed with decannulation, and parameters used to predict decannulation outcomes.
Practices on liberation from venovenous ECMO are heterogeneous and are influenced strongly by clinician preference. Additional research on liberation thresholds is needed to define optimal liberation strategies and to close existing knowledge gaps in essential topics on liberation from venovenous ECMO.
安全且及时地脱离静脉-静脉体外膜肺氧合（ECMO）有望缩短 ECMO 持续时间、降低并发症风险和治疗费用。然而，如何有效地使患者脱离静脉-静脉 ECMO 仍研究不足。
目前关于静脉-静脉 ECMO 脱离的证据状况如何？
我们在 Medline 和 EMBASE 中系统地检索了关于静脉-静脉 ECMO 脱离的相关文献。如果手稿提供了以下任何内容，就将其纳入：脱离准备的标准、脱离方案或成功脱管或脱管失败的定义。我们纳入了随机试验、观察性试验、叙述性综述、指南、社论和评论。我们排除了仅包含单一病例报告或无法获取全文的引文。
我们筛选了 1467 条引文，确定了 39 篇关于静脉-静脉 ECMO 脱离的关键文献。然后，我们将数据总结为五个主要主题：目前用于脱离的策略、定义脱离准备的标准、进行脱离试验、用于继续脱管的标准以及用于预测脱管结果的参数。
静脉-静脉 ECMO 脱离的实践存在差异，强烈受到临床医生偏好的影响。需要进一步研究脱离阈值，以确定最佳的脱离策略，并填补静脉-静脉 ECMO 脱离中基本主题的现有知识空白。
