Jendoubi Ali, de Roux Quentin, Ribot Solène, Vanden Bulcke Aurore, Miard Camille, Tiquet Bérénice, Ghaleh Bijan, Tissier Renaud, Kohlhauer Matthias, Mongardon Nicolas
Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; École Nationale Vétérinaire d'Alfort, IMRB, AfterROSC Network, F-94700 Maisons-Alfort, France; Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France..
Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France..
J Crit Care. 2025 Apr;86:155007. doi: 10.1016/j.jcrc.2024.155007. Epub 2024 Dec 21.
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a cardiocirculatory support has tremendously increased in critically ill patients. Although fluid therapy is an essential component of the hemodynamic management of VA-ECMO patients, the optimal fluid resuscitation strategy remains controversial. We performed a scoping review to map out the existing knowledge on fluid management in terms of fluid type, dosing and the impact of fluid balance on VA-ECMO patient outcomes.
A literature search within PubMed and EMBASE was conducted from database inception to April 2024. We included all studies involving critically ill adult patients, supported by VA-ECMO regardless of clinical indication (cardiogenic shock or extracorporeal cardiopulmonary resuscitation) with or without Renal Replacement Therapy and describing fluid resuscitation strategies or focusing on fluid type or reporting the impact of fluid balance on clinical outcomes and mortality. Details of study population, ECMO indications, fluid types, resuscitation strategies, fluid balance and outcome measures were extracted.
Sixteen studies met inclusion criteria, including 14 clinical studies and two experimental animal studies. We found a lack of studies comparing restrictive and liberal approaches. No study has compared the efficacy and safety of balanced and saline solutions. The place of albumin, as an alternative fluid, should be investigated. Despite their heterogeneity, studies found a negative impact of both early and cumulative fluid overload on survival and renal outcomes.
The available literature on the fluid management in VA-ECMO setting is scarce. More high-quality evidence is needed regarding optimal fluid dosing, type and resuscitation endpoints in order to standardize practice and improve outcomes.
在危重症患者中，静脉-动脉体外膜肺氧合（VA-ECMO）作为一种心脏循环支持手段的应用已大幅增加。尽管液体治疗是VA-ECMO患者血流动力学管理的重要组成部分，但最佳的液体复苏策略仍存在争议。我们进行了一项范围综述，以梳理关于液体管理的现有知识，包括液体类型、剂量以及液体平衡对VA-ECMO患者预后的影响。
在PubMed和EMBASE数据库中进行文献检索，检索时间从数据库建立至2024年4月。我们纳入了所有涉及成年危重症患者的研究，这些患者接受VA-ECMO支持，无论临床指征（心源性休克或体外心肺复苏）如何，有无肾脏替代治疗，且描述了液体复苏策略，或聚焦于液体类型，或报告了液体平衡对临床结局和死亡率的影响。提取了研究人群、ECMO指征、液体类型、复苏策略、液体平衡和结局指标的详细信息。
16项研究符合纳入标准，包括14项临床研究和2项实验动物研究。我们发现缺乏比较限制性和宽松性方法的研究。没有研究比较平衡液和生理盐水的疗效和安全性。白蛋白作为替代液体的作用有待研究。尽管研究存在异质性，但发现早期和累积液体超负荷均对生存和肾脏结局有负面影响。
关于VA-ECMO环境下液体管理的现有文献较少。需要更多高质量证据来明确最佳液体剂量、类型和复苏终点，以规范实践并改善预后。
