Safety and Outcomes of Mobile ECMO Using a Bicaval Dual-Stage Venous Catheter
Safety and Outcomes of Mobile ECMO Using a Bicaval Dual-Stage Venous Catheter
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DOI：
10.1097/mat.0000000000000482
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发表时间：
2017-05-01
期刊：
影响因子：
4.2
通讯作者：
Peek, Giles
中科院分区：
文献类型：
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作者：
Kanji, Husein D.;Chouldechova, Alexandra;Peek, Giles
关于成人移动式(医院间)体外膜氧合(ECMO)的安全性和有效性，特别是对插管策略的研究，发表的数据很少。我们试图研究需要活动的双腔双腔导管插管患者与传统ECMO患者的结果。具体地说，我们评估了在启动过程中使用这种插管策略的安全性，在运输和整体性能方面。进行多因素调整，以报告调整后的6个月存活期，以及插管和ECMO操作的并发症和表现。从2010年到2014年，共有170名严重低氧性呼吸衰竭患者纳入我们的队列研究。改善的住院存活率和调整后的较低的6个月死亡率有利于流动ECMO组(86%比79%；优势比[OR]0.24[0.07-0.69])。两组的体外反搏效果和并发症相似。在插管和运输过程中，没有报告与ECMO插管相关的严重并发症。我们的结论是，在转诊部位使用在透视引导下建立的双腔双腔导管是安全的，应该考虑用于流动的ECMO患者。此外，在严重缺氧症患者中，流动ECMO与意外的死亡率收益相关。需要进一步的前瞻性研究来阐明这一发现。
There is little published data on the safety and effectiveness of mobile (inter-hospital) extracorporeal membrane oxygenation (ECMO) in adults, particularly focusing on the cannulation strategy. We sought to study the outcomes of patients cannulated with a bicaval dual lumen catheter needing mobile compared with conventional ECMO. Specifically, we evaluated the safety of using this cannulation strategy during initiation, in transport and overall performance. Multivariate adjustment was performed to report on adjusted 6 month survival as well as complications and performance from cannulation and the ECMO run. A total of 170 consecutive patients (44 mobile ECMO, 126 conventional ECMO) with severe hypoxemic respiratory failure were included in our cohort from 2010 to 2014. Improved in-hospital survival and adjusted lower 6 month mortality favored the mobile ECMO group (86% vs. 79%; odds ratio [OR] 0.24 [0.07-0.69]). Performance of ECMO and complications were similar between the two groups. There were no serious ECMO cannulation-related complications reported during cannulation and on transport. We conclude that the use of bicaval dual lumen catheters instituted with fluoroscopy guidance at referral sites is safe and should be considered in mobile ECMO patients. Furthermore, mobile ECMO is associated with an unexpected mortality benefit in severely hypoxemic patients. Further prospective study is needed to elucidate this finding.