Masi Paul, Gouriet Loic, Radu Costin, Folliguet Thierry, Fiore Antonio, Gallet Romain, Bagate François, Mekontso Dessap Armand, De Prost Nicolas
From the Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, Créteil, France.
Univ Paris Est Créteil, Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis (CARMAS), Créteil, France.
ASAIO J. 2025 Feb 1;71(2):120-127. doi: 10.1097/MAT.0000000000002270. Epub 2024 Jul 25.
The clinical tolerance of extracorporeal membrane oxygenation (ECMO) membrane changes in acute respiratory distress syndrome (ARDS) patients under veno-venous ECMO (VV-ECMO) has not been reported. The aim of this study was to describe the tolerance of membrane change. Patients requiring VV-ECMO were retrospectively included between March 2020 and May 2022. In case of membrane dysfunction or an increase in hemolysis markers or an alteration in gas exchange, a membrane change was performed. The primary outcome was a composite measure defined as the occurrence of at least one of the following events within 1 hour of membrane change: severe hypoxemia, hemodynamic collapse, bradycardia, arrhythmia, cardiac arrest, and death. During the study period, 70 patients required a VV-ECMO, 29 (41%) of whom died. Thirty-two patients required a membrane change for a total of 56 changes. The primary outcome occurred for 33 (59%) changes. Arterial desaturation <80% occurred for all complicated membrane changes and cardiac arrest concerned nine changes (16%). Low tidal volume (V T ), respiratory system compliance (Crs), PaO 2 , and high ECMO blood flow (Q ECMO ) were associated with poor tolerance of membrane change. Threshold values of 130 ml for V T , 9.3 cm H 2 O for Crs, 72 mm Hg for PaO 2 , and 3.65 L/minute for Q ECMO best determined the risk of poor tolerance of membrane change.
体外膜肺氧合（ECMO）膜在急性呼吸窘迫综合征（ARDS）患者接受静脉-静脉ECMO（VV-ECMO）时的临床耐受性尚未见报道。本研究的目的是描述膜更换的耐受性。回顾性纳入2020年3月至2022年5月期间需要VV-ECMO的患者。在出现膜功能障碍、溶血标志物增加或气体交换改变的情况下，进行膜更换。主要结局是一个综合指标，定义为膜更换后1小时内发生以下至少一项事件：严重低氧血症、血流动力学崩溃、心动过缓、心律失常、心脏骤停和死亡。在研究期间，70例患者需要VV-ECMO，其中29例（41%）死亡。32例患者需要进行膜更换，共更换56次。33次（59%）更换发生了主要结局。所有复杂的膜更换均出现动脉血氧饱和度<80%，心脏骤停涉及9次更换（16%）。低潮气量（VT）、呼吸系统顺应性（Crs）、动脉血氧分压（PaO2）和高ECMO血流量（QECMO）与膜更换耐受性差相关。VT为130 ml、Crs为9.3 cmH2O、PaO2为72 mmHg和QECMO为3.65 L/分钟的阈值最能确定膜更换耐受性差的风险。
