Chen Lihua, Wang Xinning, Wang Jing, He Tingting, Huang Yao, Sheng Qingqing, Tan Yufeng, Zhang Shuqin, Huang Xiaoqun, Xu Mengmeng, Sang Ling, Zhang Jie, Xu Yonghao
Department of Critical Care Medicine, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510230, Guangdong, China.
School of Nursing, Guangzhou Medical University, Guangzhou 510182, Guangdong, China. Corresponding author: Chen Lihua, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 Nov;36(11):1190-1195. doi: 10.3760/cma.j.cn121430-20240319-00255.
To provide evidence-based recommendations for the prevention and management of lower limb ischemia in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) patients during treatment according to search, evaluate, and summarize the best evidence on the prevention and management of lower limb ischemia in patients with VA-ECMO.
Based on the PIPOST framework (population, intervention, professional, outcome, setting, and type of evidence), an evidence-based question was formulated. A systematic search was conducted according to the "6S" evidence pyramid model in both domestic and international databases, as well as professional association websites, for all evidence related to the prevention and management of lower limb ischemia in VA-ECMO patients (aged ≥18 years). The types of evidence included clinical decisions, guidelines, expert consensus, systematic reviews, evidence summaries, and original studies. The search was conducted from the construction of the databases to February 2024. Two researchers independently conducted a literature quality evaluation, extracted and summarized evidence from the studies that met the quality criteria.
A total of 13 articles were included, consisting of 3 clinical decisions, 3 guidelines, 3 expert consensus, 3 systematic reviews, and 1 randomized controlled trial. A total of 18 pieces of evidence in 7 dimensions were summarized, including risk factors of VA-ECMO lower limb ischemia, evaluation before catheterization, evaluation and monitoring during treatment, prevention of lower limb ischemia, treatment of lower limb ischemia, management of distal perfusion catheter (DPC), and monitoring after VA-ECMO weaning.
This evidence summary provides evidence-based recommendations for the prevention and management of lower limb ischemia in VA-ECMO patients, aiming to assist clinical healthcare professionals in developing tailored strategies for the prevention and management of lower limb ischemia based on during VA-ECMO support.
通过检索、评估和总结静脉-动脉体外膜肺氧合（VA-ECMO）患者下肢缺血预防与管理的最佳证据，为VA-ECMO患者治疗期间下肢缺血的预防与管理提供循证建议。
基于PIPOST框架（人群、干预措施、专业人员、结局、环境和证据类型）提出循证问题。按照“6S”证据金字塔模型在国内外数据库以及专业协会网站上进行系统检索，查找与年龄≥18岁的VA-ECMO患者下肢缺血预防与管理相关的所有证据。证据类型包括临床决策、指南、专家共识、系统评价、证据总结和原始研究。检索时间从数据库建立至2024年2月。两名研究人员独立进行文献质量评估，从符合质量标准的研究中提取并总结证据。
共纳入13篇文章，包括3篇临床决策、3篇指南、3篇专家共识、3篇系统评价和1篇随机对照试验。共总结了7个维度的18条证据，包括VA-ECMO下肢缺血的危险因素、置管前评估、治疗期间评估与监测、下肢缺血预防、下肢缺血治疗、远端灌注导管（DPC）管理以及VA-ECMO撤机后监测。
本证据总结为VA-ECMO患者下肢缺血的预防与管理提供了循证建议，旨在帮助临床医护人员制定基于VA-ECMO支持期间下肢缺血预防与管理的个性化策略。
