Long-Term Venovenous Extracorporeal Membrane Oxygenation Support for Acute Respiratory Distress Syndrome
Long-Term Venovenous Extracorporeal Membrane Oxygenation Support for Acute Respiratory Distress Syndrome
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DOI：
10.1016/j.athoracsur.2015.05.088
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发表时间：
2015-12-01
影响因子：
4.6
通讯作者：
Griffith, Bartley P.
中科院分区：
文献类型：
--
作者：
Kon, Zachary N.;Dahi, Siamak;Griffith, Bartley P.
背景资料。鉴于静脉静脉体外膜氧合(ECMO)技术的实质性进步，长期支持越来越可行。尽管短期ECMO作为急性呼吸窘迫综合征(ARDS)患者恢复的桥梁的益处已被很好地描述，但长期支持的有效性和结果仍不清楚。对2009年1月至2012年11月期间需要ECMO治疗ARDS的患者进行了回顾，并分别对需要ECMO支持少于3周或3周或更长时间的患者进行了分析。对人口统计学因素、ECMO变量和结果进行评估。在研究期间，55名ARDS患者接受了ECMO治疗，其中11名患者需要长期ECMO支持，平均持续时间为36天(四分位数范围：24至68天)。康复是所有患者的初始目标。两组患者ECMO前机械通气支持、疾病严重程度指数和ECMO插管策略相似。接受长期支持的8名患者(73%)顺利康复，1名患者在难治性病程后再次接受移植。接受长期支持的8名患者(73%)和接受短期支持的25名患者(57%)存活到30天并出院。以前，长期的ECMO支持被认为与不利的结果有关。然而，这项研究可能会支持ECMO支持的有效性，即使是3周或更长时间，作为恢复或移植的桥梁。(C)2015年，由胸外科医生学会主办
Background. Given substantial advances in venovenous extracorporeal membrane oxygenation (ECMO) technology, long-term support is increasingly feasible. Although the benefits of short-term ECMO as a bridge to recovery in acute respiratory distress syndrome (ARDS) are well described, the utility and outcomes of long-term support remain unclear.Methods. Patients requiring ECMO for ARDS between January 2009 and November 2012 were retrospectively reviewed and analyzed separately for those requiring ECMO support for less than 3 weeks or for 3 weeks or longer. Demographic factors, ECMO variables, and outcomes were assessed.Results. Fifty-five patients with ARDS received ECMO during the study period, with 11 patients requiring long-term ECMO support and a median duration of 36 (interquartile range: 24 to 68) days. Recovery was the initial goal in all patients. Pre-ECMO mechanical ventilatory support, indices of disease severity, and the ECMO cannulation strategy were similar between the two groups. Eight (73%) patients receiving long-term support were bridged to recovery, and 1 patient was bridged to transplantation after a refractory course. Eight (73%) patients receiving long-term support and 25 (57%) patients receiving short-term support survived to 30 days and hospital discharge.Conclusions. Previously, long-term ECMO support was thought to be associated with unfavorable outcomes. This study, however, may provide support for the efficacy of ECMO support even for 3 weeks or more as a bridge to recovery or transplantation. (C) 2015 by The Society of Thoracic Surgeons