Pre-Intubation Veno-Venous Extracorporeal Membrane Oxygenation in Patients at Risk for Respiratory Decompensation.
Pre-Intubation Veno-Venous Extracorporeal Membrane Oxygenation in Patients at Risk for Respiratory Decompensation.
复制标题
DOI：
10.1182/ject-1900035
复制
发表时间：
2020-03-01
期刊：
影响因子：
--
通讯作者：
Bharat, Ankit
中科院分区：
文献类型：
--
作者：
Karim, Azad S;Son, Andre Y;Bharat, Ankit
静脉-静脉体外膜肺氧合（VV-ECMO）已成为急性呼吸衰竭患者的潜在救生治疗方法。鉴于越来越多的文献支持在没有抗凝治疗水平的情况下使用 VV-ECMO，因此在手术前将其用于计划插管可能是可行的。在此，我们连续报道了一系列患者，这些患者在因预期的困难气道或呼吸代偿失调而进行全身麻醉之前，接受了计划的 VV-ECMO 启动，无需抗凝治疗。我们描述了在清醒患者中安全启动 VV-ECMO 的方法。我们回顾性地在前瞻性维护的数据库中确定了插管前计划启动 VV-ECMO 的患者。使用标准统计方法来确定术后结果。患者包括 3 名男性和 1 名女性，平均年龄为 34.3 ± 10.4 岁。适应症包括纵隔淋巴瘤、异物梗阻、咯血和气管食管瘘。所有患者均择期启动VV-ECMO，且未使用抗凝药物。 VV-ECMO支持的中位持续时间为2.5天（1-11天），呼吸机依赖和重症监护病房住院的中位时间分别为1天（1-23天）和5天（4-31天）。中位住院时间为 18.5 天（8-39 天）。 30 天时没有血栓并发症，也没有死亡。对于呼吸代偿失调高危患者，在插管和麻醉诱导前启动清醒 VV-ECMO 是可行且安全的。
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has emerged as a potential life-saving treatment for patients with acute respiratory failure. Given the accumulating literature supporting the use of VV-ECMO without therapeutic levels of anticoagulation, it might be feasible to use it for planned intubation before surgical procedures. Here, we report consecutive series of patients who underwent planned initiation of VV-ECMO, without anticoagulation, before induction of general anesthesia for anticipated difficult airways or respiratory decompensation. We describe the approach to safely initiate VV-ECMO in an awake patient. We retrospectively identified patients in a prospectively maintained database who underwent planned initiation of VV-ECMO before intubation. Standard statistical methods were used to determine post-procedure outcomes. Patients included were three men and one woman, with a mean age of 34.3 ± 10.4 years. Indications included mediastinal lymphoma, foreign body obstruction, hemoptysis, and tracheo-esophageal fistula. VV-ECMO was initiated electively for all patients, and no anticoagulation was used. The median duration of VV-ECMO support was 2.5 days (1-11 days), the median length of ventilator dependence and intensive care unit stay was 1 day (1-23 days) and 5 days (4-31 days), respectively. The median length of stay was 18.5 days (8-39 days). There were no thrombotic complications and no mortality at 30 days. Initiation of awake VV-ECMO is feasible and is safe before intubation and induction of anesthesia in patients at high risk for respiratory decompensation.