Djavidi Nima, Boussouar Samia, Duceau Baptiste, Bahroum Petra, Rivoal Simon, Hariri Geoffroy, Lancelot Aymeric, Dureau Pauline, Abbes Ahmed, Omar Edris, Charfeddine Ahmed, Lebreton Guillaume, Redheuil Alban, Luyt Charles-Edouard, Bouglé Adrien
Département d'Anesthésie et Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Institut de Cardiologie, Paris, France.
Unité d'Imagerie Cardiovasculaire et Thoracique, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Institut de Cardiologie, Paris, France.
Crit Care Med. 2025 Jan 1;53(1):e96-e108. doi: 10.1097/CCM.0000000000006476. Epub 2024 Nov 1.
Vascular complications after venoarterial extracorporeal membrane oxygenation (ECMO) remains poorly studied, although they may highly impact patient management after ECMO removal. Our aim was to assess their frequency, predictors, and management.
Retrospective, observational cohort study.
Two ICUs from a tertiary referral academic hospital.
Adult patients who were successfully weaned from venoarterial ECMO between January 2021 and January 2022.
None.
Vascular complications frequency related to ECMO cannula.
A total of 288 patients were implanted with venoarterial ECMO during the inclusion period. One hundred ninety-four patients were successfully weaned, and 109 underwent a CT examination to assess for vascular complications until 4 days after the weaning procedure. The median age of the cohort was 58 years (interquartile range [IQR], 46-64 yr), with a median duration of ECMO support of 7 days (IQR, 5-12 d). Vascular complications were observed in 88 patients (81%). The most frequent complication was thrombosis, either cannula-associated deep vein thrombosis (CaDVT) ( n = 63, 58%) or arterial thrombosis ( n = 36, 33%). Nonthrombotic arterial complications were observed in 48 patients (44%), with 35 (31%) presenting with bleeding. The most common site of CaDVT was the inferior vena cava, occurring in 33 (50%) of cases, with 20% of patients presenting with pulmonary embolism. There was no association between thrombotic complications and ECMO duration, anticoagulation level, or ECMO rotation flow. CT scans influenced management in 83% of patients. In-hospital mortality was 17% regardless of vascular complications.
Vascular complications related to venoarterial ECMO cannula are common after ECMO implantation. CT allows early detection of complications after weaning and impacts patient management. Patients should be routinely screened for vascular complications by CT after decannulation.
尽管静脉-动脉体外膜肺氧合（ECMO）后的血管并发症可能对ECMO撤除后的患者管理产生重大影响，但目前对此研究较少。我们的目的是评估其发生率、预测因素及处理方法。
回顾性观察队列研究。
一家三级转诊学术医院的两个重症监护病房。
2021年1月至2022年1月期间成功撤机的成年静脉-动脉ECMO患者。
无。
与ECMO插管相关的血管并发症发生率。
纳入期间共有288例患者接受了静脉-动脉ECMO植入。194例患者成功撤机，其中109例在撤机后4天内接受了CT检查以评估血管并发症。队列的中位年龄为58岁（四分位间距[IQR]，46-64岁），ECMO支持的中位时长为7天（IQR，5-12天）。88例患者（81%）出现血管并发症。最常见的并发症是血栓形成，包括插管相关的深静脉血栓形成（CaDVT）（n = 63，58%）或动脉血栓形成（n = 36，33%）。48例患者（44%）出现非血栓性动脉并发症，其中35例（31%）有出血表现。CaDVT最常见的部位是下腔静脉，33例（50%）出现于此，20%的患者发生肺栓塞。血栓形成并发症与ECMO时长、抗凝水平或ECMO旋转流量之间无相关性。83%的患者CT扫描结果影响了治疗方案。无论有无血管并发症，住院死亡率均为17%。
静脉-动脉ECMO插管相关的血管并发症在ECMO植入后很常见。CT可在撤机后早期发现并发症并影响患者管理。脱管后应常规通过CT对患者进行血管并发症筛查。
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