Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan , Hubei, 430022, China.
Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan , Hubei, 430030, China.
BMC Anesthesiol. 2024 Nov 27;24(1):437. doi: 10.1186/s12871-024-02827-9.
Extracorporeal membrane oxygenation (ECMO) is mainly used for support of patients with cardiopulmonary collapse. The increasing use of ECMO has shown promising outcomes; however, it still carries the risk of significant complications. Inferior vena cava (IVC) thrombosis is an underestimated complication.
We described a series of 5 ECMO patients diagnosed with IVC thrombosis in our institution. An electronic literature search of the PubMed, Cochrane Library and Web of Science databases. A total of 12 cases were identified.
The occurrence of IVC thrombosis in ECMO patients is not uncommon. In our case series, elevated CRP and PCT levels and activated partial thromboplastin times (aPTT) of less than 50 s during ECMO operation were observed. In the literature review, a higher proportion of veno-arterial (VA) ECMO application (67%; 8/12) was presented in patients with IVC thrombosis. Eight patients (73%; 8/11) were monitored for anticoagulation using either aPTT or a combination of aPTT and ACT, with all aPTT measurements achieving the target range for anticoagulation. The mainstay of treatment for IVC thrombosis was anticoagulation alone (75%; 9/12). After the treatment, IVC thrombosis disappeared in the majority of patients (75%; 9/12) and there was no thrombosis-related mortality.
Factors such as elevated CRP and PCT levels, low aPTT levels, and the use of VA ECMO may contribute to the development of ECMO-related IVC thrombosis. Monitoring of anticoagulation with aPTT alone or in combination with ACT during ECMO may have inherent limitations. Anticoagulation alone may be an effective treatment for IVC thrombosis.
体外膜肺氧合（ECMO）主要用于支持心肺衰竭的患者。ECMO 的应用越来越广泛，其结果也令人充满希望，但它仍然存在严重并发症的风险。下腔静脉（IVC）血栓形成是一种被低估的并发症。
我们描述了在我们机构中诊断出的 5 例 ECMO 患者的 IVC 血栓形成系列病例。在 PubMed、Cochrane 图书馆和 Web of Science 数据库中进行电子文献检索。共确定了 12 例病例。
ECMO 患者中 IVC 血栓形成并不少见。在我们的病例系列中，观察到 ECMO 治疗过程中 CRP 和 PCT 水平升高，以及部分凝血活酶时间（aPTT）低于 50 s。在文献综述中，IVC 血栓形成患者中静脉-动脉（VA）ECMO 应用比例较高（67%；8/12）。8 例患者（73%；8/11）使用 aPTT 或 aPTT 联合 ACT 监测抗凝，所有 aPTT 测量均达到抗凝的目标范围。IVC 血栓形成的主要治疗方法是单独抗凝（75%；9/12）。治疗后，大多数患者的 IVC 血栓形成消失（75%；9/12），且无与血栓相关的死亡率。
CRP 和 PCT 水平升高、aPTT 水平降低以及使用 VA ECMO 等因素可能导致 ECMO 相关 IVC 血栓形成。在 ECMO 期间单独使用 aPTT 或与 ACT 联合监测抗凝可能存在固有局限性。单独抗凝可能是治疗 IVC 血栓形成的有效方法。
