Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA.
Crit Care Med. 2023 Dec 1;51(12):1716-1726. doi: 10.1097/CCM.0000000000006014. Epub 2023 Aug 7.
To determine whether multisite versus single-site dual-lumen (SSDL) cannulation is associated with outcomes for COVID-19 patients requiring venovenous extracorporeal membrane oxygenation (VV-ECMO).
Retrospective analysis of the Extracorporeal Life Support Organization Registry. Propensity score matching (2:1 multisite vs SSDL) was used to control for confounders.
The matched cohort included 2,628 patients (1,752 multisite, 876 SSDL) from 170 centers. The mean ( sd ) age in the entire cohort was 48 (11) years, and 3,909 (71%) were male. Patients were supported with mechanical ventilation for a median (interquartile range) of 79 (113) hours before VV-ECMO support.
None.
The primary outcome was 90-day survival. Secondary outcomes included survival to hospital discharge, duration of ECMO support, days free of ECMO support at 90 days, and complication rates.
There was no difference in 90-day survival (49.4 vs 48.9%, p = 0.66), survival to hospital discharge (49.8 vs 48.2%, p = 0.44), duration of ECMO support (17.9 vs 17.1 d, p = 0.82), or hospital length of stay after cannulation (28 vs 27.4 d, p = 0.37) between multisite and SSDL groups. More SSDL patients were extubated within 24 hours (4% vs 1.9%, p = 0.001). Multisite patients had higher ECMO flows at 24 hours (4.5 vs 4.1 L/min, p < 0.001) and more ECMO-free days at 90 days (3.1 vs 2.0 d, p = 0.02). SSDL patients had higher rates of pneumothorax (13.9% vs 11%, p = 0.03). Cannula site bleeding (6.4% vs 4.7%, p = 0.03), oxygenator failure (16.7 vs 13.4%, p = 0.03), and circuit clots (5.5% vs 3.4%, p = 0.02) were more frequent in multisite patients.
In this retrospective study of COVID-19 patients requiring VV-ECMO, 90-day survival did not differ between patients treated with a multisite versus SSDL cannulation strategy and there were only modest differences in major complication rates. These findings do not support the superiority of either cannulation strategy in this setting.
确定多部位与单部位双腔（SSDL）置管在 COVID-19 患者需要静脉-静脉体外膜肺氧合（VV-ECMO）治疗时的结果是否存在差异。
对体外生命支持组织登记处进行回顾性分析。采用倾向评分匹配（2:1 多部位与 SSDL）来控制混杂因素。
匹配队列包括来自 170 个中心的 2628 名患者（1752 名多部位，876 名 SSDL）。整个队列的平均（标准差）年龄为 48（11）岁，3909 名（71%）为男性。患者在接受 VV-ECMO 支持前，接受机械通气的中位（四分位间距）时间为 79（113）小时。
无。
主要结局为 90 天生存率。次要结局包括存活至出院、ECMO 支持时间、90 天无 ECMO 支持天数和并发症发生率。
90 天生存率（49.4%与 48.9%，p=0.66）、存活至出院（49.8%与 48.2%，p=0.44）、ECMO 支持时间（17.9 天与 17.1 天，p=0.82）和置管后住院时间（28 天与 27.4 天，p=0.37）在多部位与 SSDL 组之间无差异。多部位组有更多的 SSDL 患者在 24 小时内拔管（4%与 1.9%，p=0.001）。多部位患者在 24 小时时 ECMO 流量更高（4.5 升/分钟与 4.1 升/分钟，p<0.001），90 天无 ECMO 支持天数更多（3.1 天与 2.0 天，p=0.02）。SSDl 患者气胸发生率更高（13.9%与 11%，p=0.03）。多部位患者的导管部位出血（6.4%与 4.7%，p=0.03）、氧合器故障（16.7%与 13.4%，p=0.03）和回路凝块（5.5%与 3.4%，p=0.02）更为频繁。
在这项 COVID-19 患者需要 VV-ECMO 治疗的回顾性研究中，多部位与 SSDL 置管策略治疗的患者 90 天生存率无差异，主要并发症发生率也只有微小差异。这些发现并不支持在这种情况下任何一种置管策略的优越性。
