Extracorporeal Membrane Oxygenation by Single-Vessel Access in Adults: Advantages and Limitations
Extracorporeal Membrane Oxygenation by Single-Vessel Access in Adults: Advantages and Limitations
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DOI：
10.1097/mat.0b013e31826a8a32
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发表时间：
2012-11-01
期刊：
影响因子：
4.2
通讯作者：
Mueller, Thomas
中科院分区：
文献类型：
--
作者：
Camboni, Daniele;Philipp, Alois;Mueller, Thomas
静脉-静脉体外膜氧合（vvECMO）通常需要两根血管插管。在此，我们报告我们使用“Wang-Zwische”（WZ）双腔插管的初步经验。36例患者均行单静脉插管。进行回顾性分析。比较了标准双管插管的流动特性。患者平均年龄48 +/- 15岁（体重指数[BMI] 32 +/- 13 kg/m(2)）。32例（89%）患者在超声或透视引导下经皮置管，时间不超过30分钟。9例患者在体外膜氧合（ECMO）支持下部分活动。所有患者的氧合（部分动脉氧压[PaO2]/吸入氧分数[FiO(2)]）从ECMO前的66 mm Hg（四分位数范围[IQR] 58-87 mm Hg）显著改善至24小时后的117 mm Hg （IQR 95-195 mm Hg, p = 0.001）。7例患者（19%）发生了非致命性不良事件，包括3例脱位，2例部分插管血栓形成，1例心室穿孔和1例腹膜后出血。与WZ入路相比，标准(S)双血管入路在流量为2.5 L/min时的引流负压明显较低（S: -9 mm Hg； IQR: -3至-24 mm Hg，与WZ: -23 mm Hg； IQR: -4至-40 mm Hg； p = 0.04）。与标准插管相比，WZ套管除了提供充足的气体交换外，还具有一定的优势，包括在特定患者中方便插管和改善活动。中国生物医学工程学报，2012;38(5):616-621。
Veno-venous extracorporeal membrane oxygenation (vvECMO) conventionally requires the cannulation of two vessels. Here we report our initial experience with the "Wang-Zwische" (WZ) double-lumen cannula.In a group of n = 36 patients single venous cannulation for vvECMO was performed. A retrospective analysis was executed. A comparison of flow characteristics to standard two-vessel cannulation was performed. Mean age of the patient population was 48 +/- 15 years (body mass index [BMI] 32 +/- 13 kg/m(2)). In n = 32 patients (89%) the cannula was implanted percutaneously under echo or fluoroscopic guidance in less than 30 minutes. Nine patients were partially mobilized on extracorporeal membrane oxygenation (ECMO) support. Oxygenation (partial arterial oxygen tension [PaO2]/fraction of inspired oxygen [FiO(2)]) improved significantly in all patients from 66 mm Hg (interquartile range [IQR] 58-87 mm Hg) before ECMO to 117 mm Hg (IQR 95-195 mm Hg, p = 0.001) after 24 hours. In seven patients (19%) nonfatal adverse events occurred, including three dislocations, two partial cannula thrombosis, one ventricular perforation, and one retroperitoneal hemorrhage. The negative pressures for drainage at a flow of 2.5 L/min were significantly lower in a standard (S) two-vessel approach compared with a WZ approach (S: -9 mm Hg; IQR -3 to -24 mm Hg, vs. WZ: -23 mm Hg; IQR -4 to -40 mm Hg; p = 0.04). The WZ cannula offers sufficient gas exchange in addition to certain advantages over standard cannulation, including facilitated cannulation in selected patients and improved mobilization. ASAIO Journal 2012;58:616-621.