Interdisciplinary Medical Intensive Care, Faculty of Medicine, University of Freiburg Medical Center, University of Freiburg, Freiburg, Germany.
Department of Medicine IV - Nephrology and Primary Care, Faculty of Medicine, University of Freiburg Medical Center, University of Freiburg, Freiburg, Germany.
Artif Organs. 2023 Oct;47(10):1654-1662. doi: 10.1111/aor.14604. Epub 2023 Jul 7.
Mobilization is important in longer courses in intensive care unit (ICU), typical for patients requiring venovenous extracorporeal membrane oxygenation (V-V ECMO). For patients supported with ECMO, especially out-of-bed mobilizations improve outcome. We hypothesized that utilization of a dual lumen cannula (DLC) for V-V ECMO would facilitate out-of-bed mobilization compared to single lumen cannulas (SLC).
Retrospective single center registry study including all V-V ECMO patients cannulated between 10/2010 and 05/2021 for respiratory failure.
The registry included 355 V-V ECMO patients (median age 55.6 years, 31.8% female, 27.3% with preexisting pulmonary disease), 289/355 (81.4%) primary cannulated with DLC, and 66/355 (18.6%) using SLC. Both groups had similar pre-ECMO characteristics. The runtime of the first ECMO cannula was significantly longer in DLC compared to SLC (169 vs. 115 h, p = 0.015). The frequency of prone positioning during V-V ECMO was similar in both groups (38.4 vs. 34.8%, p = 0.673). There was no difference in in-bed mobilization (41.2 vs. 36.4%, for DLC and SLC, respectively, p = 0.491). Patients with DLC were more often mobilized out-of-bed (25.6 vs. 12.1%, OR 2.495 [95% CI 1.150 to 5.268], for DLC and SLC, respectively, p = 0.023). Hospital survival was similar in both groups (46.4 vs. 39.4%, for DLC and SLC, respectively, p = 0.339).
Patients cannulated with a dual lumen cannula for V-V ECMO support were significantly more often mobilized out-of-bed. Since mobilization is important in prolonged ICU courses typical for ECMO patients, this might be an important benefit. Other benefits of DLC were the longer runtime of the initial cannula set and fewer suction events.
在需要静脉-静脉体外膜肺氧合（V-V ECMO）的患者中，长时间的重症监护病房（ICU）治疗中，进行体外膜肺氧合（ECMO）患者的移动非常重要。对于接受 ECMO 支持的患者，尤其是离床活动可改善预后。我们假设，与单腔管（SLC）相比，使用双腔管（DLC）进行 V-V ECMO 可更方便地进行离床活动。
回顾性单中心登记研究，纳入 2010 年 10 月至 2021 年 5 月期间因呼吸衰竭而接受 V-V ECMO 治疗的所有患者。
该登记研究纳入了 355 例 V-V ECMO 患者（中位年龄 55.6 岁，31.8%为女性，27.3%患有预先存在的肺部疾病），289/355 例（81.4%）患者初次插管时使用 DLC，66/355 例（18.6%）患者使用 SLC。两组患者的 ECMO 前特征相似。与 SLC 相比，DLC 中首次 ECMO 插管的运行时间明显更长（169 小时 vs. 115 小时，p=0.015）。两组患者在 V-V ECMO 期间进行俯卧位通气的频率相似（38.4% vs. 34.8%，p=0.673）。两组患者在床旁活动方面没有差异（DLC 和 SLC 组分别为 41.2%和 36.4%，p=0.491）。DLC 组患者更常离床活动（25.6% vs. 12.1%，DLC 和 SLC 组，分别，p=0.023）。两组患者的住院存活率相似（DLC 和 SLC 组分别为 46.4%和 39.4%，p=0.339）。
使用 DLC 进行 V-V ECMO 支持的患者更常离床活动。由于移动在 ECMO 患者典型的长时间 ICU 治疗中非常重要，这可能是一个重要的优势。DLC 的其他优势包括初始插管的运行时间更长和更少的抽吸事件。
