From the Department of Medicine I-Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria.
ASAIO J. 2024 Nov 1;70(11):987-993. doi: 10.1097/MAT.0000000000002223. Epub 2024 May 7.
Venovenous extracorporeal membrane oxygenation (VV ECMO) facilitates the reduction of mechanical ventilation (MV) support in acute respiratory failure. Contrary to increasing evidence regarding its initiation, the optimal timing of VV ECMO weaning in interaction with MV weaning is undetermined. In this retrospective study, 47 patients who received VV ECMO between 2013 and 2021 and survived ≥1 day after ECMO cessation were divided according to their MV status before ECMO removal: 28 patients were classified into an "ECMO weaning during assisted MV/spontaneous breathing" group and 19 into an "ECMO weaning during controlled MV" group. Extracorporeal membrane oxygenation duration was longer in the "assisted MV/spontaneous breathing" group (17 [Interquartile range (IQR) = 11-35] vs. 6 [5-11] days, p < 0.001). These patients had a longer intensive care unit (ICU) stay after ECMO start (48 [29-66] vs. 31 [15-40] days, p = 0.01). No significant differences were found for MV duration after ECMO start (30 [19-45] vs. 19 [12-30] days, p = 0.06) and further ICU survival (86% vs. 89%, p ≥ 0.9). There was a trend toward more patients with mechanical ECMO complications in the "assisted MV/spontaneous breathing" group (57% vs. 32%, p = 0.08). Thus, our results suggest a possible benefit of early ECMO weaning during controlled MV.
静脉-静脉体外膜肺氧合（VV ECMO）有助于减少急性呼吸衰竭患者的机械通气（MV）支持。与 MV 脱机的逐渐增加的证据相反，VV ECMO 脱机与 MV 脱机相互作用的最佳时机尚未确定。在这项回顾性研究中，根据 ECMO 移除前的 MV 状态，将 2013 年至 2021 年间接受 VV ECMO 并在 ECMO 停止后存活≥1 天的 47 名患者进行分组：28 名患者分为“在辅助 MV/自主呼吸时进行 ECMO 脱机”组，19 名患者分为“在控制 MV 时进行 ECMO 脱机”组。“辅助 MV/自主呼吸”组的体外膜肺氧合时间更长（17 [四分位距（IQR）= 11-35] vs. 6 [5-11] 天，p < 0.001）。这些患者在 ECMO 启动后的 ICU 停留时间更长（48 [29-66] vs. 31 [15-40] 天，p = 0.01）。ECMO 启动后 MV 持续时间无显著差异（30 [19-45] vs. 19 [12-30] 天，p = 0.06），进一步的 ICU 生存率也无显著差异（86% vs. 89%，p ≥ 0.9）。“辅助 MV/自主呼吸”组中机械 ECMO 并发症的患者比例有增加的趋势（57% vs. 32%，p = 0.08）。因此，我们的结果表明，在控制 MV 时早期进行 ECMO 脱机可能具有一定的益处。
