Rottmann Felix A, Noe Christian, Bemtgen Xavier, Maier Sven, Supady Alexander, Wengenmayer Tobias, Staudacher Dawid L
Department of Medicine IV - Nephrology and Primary Care, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
Interdisciplinary Medical Intensive Care, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
Front Med (Lausanne). 2023 Sep 28;10:1271540. doi: 10.3389/fmed.2023.1271540. eCollection 2023.
Venovenous extracorporeal membrane oxygenation (V-V ECMO) can be considered in critically ill patient in severe pulmonary failure. However, the mobilization of patients on V-V ECMO can be challenging due to logistic and safety concerns. This study aimed to investigate whether 30 days survival was improved in patients who were mobilized during V-V ECMO support.
We conducted a retrospective cohort all-comer study that included all patients cannulated for V-V ECMO at a single center. Patients with a V-V ECMO duration below 24 h were excluded from the analysis. The patients were grouped based on the ICU mobility scale documented during V-V ECMO support. The primary endpoint was 30 days survival, and secondary endpoints included weaning from ECMO and mechanical ventilation, as well as hospital survival.
A total of 343 patients were included in the study, with a median age of 56 years and 32% were female. Among them, 28% had chronic lung disease. The ICU mobilization scale ≥2 during ECMO was documented in 62/343 (18%) patients. There were no significant differences in age, gender and preexisting lung disease. Duration of ICU stay (13.1 vs. 15.6 days), time on ECMO (186 vs. 190 h) and mechanical ventilation (11.2 vs. 13.6 days) were slightly shorter in patients with ICU mobility scale <2 compared to those with ≥2 (all = 0.0001). However, patients with ICU mobilization scale ≥2 showed significantly better 30 days survival (71.0 vs. 48.0%, OR 2.6 (1.5 to 4.8), = 0.0012) compared to those with <2. In the ≥2 mobility scale group, a significantly higher number of patients were successfully weaned from the ventilator (61.3 vs. 46.6%, OR 1.8 (1.0 to 3.2), = 0.049). A stronger correlation was observed between more intense mobilizations, such as being in a standing position (OR 5.0 (1.7 to 14.0), = 0.0038), and higher 30 days survival.
The findings of this study suggest that active mobilization during V-V ECMO support is associated with improved 30 days survival and successful weaning from the respirator. Incorporating mobilization as part of the therapeutic approach during ECMO support may offer potential benefits for critically ill patients.
对于严重肺衰竭的重症患者，可考虑采用静脉-静脉体外膜肺氧合（V-V ECMO）治疗。然而，由于后勤保障和安全方面的考虑，对接受V-V ECMO治疗的患者进行活动安排具有挑战性。本研究旨在调查在V-V ECMO支持期间进行活动安排的患者30天生存率是否有所提高。
我们进行了一项回顾性队列全人群研究，纳入了在单一中心接受V-V ECMO插管的所有患者。V-V ECMO持续时间低于24小时的患者被排除在分析之外。根据V-V ECMO支持期间记录的ICU活动量表对患者进行分组。主要终点是30天生存率，次要终点包括ECMO和机械通气的撤机情况以及医院生存率。
本研究共纳入343例患者，中位年龄为56岁，女性占32%。其中，28%患有慢性肺病。62/343（18%）例患者在ECMO期间的ICU活动量表≥2。在年龄、性别和既往肺病方面无显著差异。与ICU活动量表≥2的患者相比，ICU活动量表<2的患者的ICU住院时间（13.1天对15.6天）、ECMO使用时间（186小时对190小时）和机械通气时间（11.2天对13.6天）略短（均P = 0.0001）。然而，与活动量表<2的患者相比，ICU活动量表≥2的患者30天生存率显著更高（71.0%对48.0%，OR 2.6（1.5至4.8），P = 0.0012）。在活动量表≥2的组中，成功脱机的患者数量显著更多（61.3%对46.6%，OR 1.8（1.0至3.2），P = 0.049）。观察到更积极的活动安排，如站立位，与更高的30天生存率之间存在更强的相关性（OR 5.0（1.7至14.0），P = 0.0038）。
本研究结果表明，在V-V ECMO支持期间进行积极活动安排与30天生存率提高及成功脱机相关。将活动安排纳入ECMO支持期间的治疗方法可能为重症患者带来潜在益处。
