PDF(Pubmed)
Abstract：
OBJECTIVE: Dual-lumen cannulas for veno-venous (VV) extracorporeal membrane oxygenation (ECMO) support are typically inserted in the right internal jugular vein (RIJV); however, some scenarios can make this venous route inaccessible. This multicentre case series aims to evaluate if single-site cannulation using an alternative venous access is safe and feasible in patients with an inaccessible RIJV.
METHODS: We performed a multi-institutional retrospective analysis including high-volume ECMO centres with substantial experience in dual-lumen cannulation (DLC) (defined as >10 DLC per year). Three centres [Freiburg (Germany), Toronto (Canada) and Vienna (Austria)] agreed to share their data, including baseline characteristics, technical ECMO and cannulation data as well as complications related to ECMO cannulation and outcome.
RESULTS: A total of 20 patients received alternative DLC for respiratory failure. Cannula insertion sites included the left internal jugular vein (n = 5), the right (n = 7) or left (n = 3) subclavian vein and the right (n = 4) or left (n = 1) femoral vein. The median cannula size was 26 (19-28) French. The median initial target ECMO flow was 2.9 (1.8-3.1) l/min and corresponded with used cannula size and estimated cardiac output. No procedural complications were reported during cannulation and median ECMO runtime was 15 (9-22) days. Ten patients were successfully bridged to lung transplantation (n = 5) or lung recovery (n = 5). Ten patients died during or after ECMO support.
CONCLUSIONS: Alternative venous access sites for single-site dual-lumen catheters are a safe and feasible option to provide veno-venous ECMO support to patients with inaccessible RIJV.
METHODS: We performed a multi-institutional retrospective analysis including high-volume ECMO centres with substantial experience in dual-lumen cannulation (DLC) (defined as >10 DLC per year). Three centres [Freiburg (Germany), Toronto (Canada) and Vienna (Austria)] agreed to share their data, including baseline characteristics, technical ECMO and cannulation data as well as complications related to ECMO cannulation and outcome.
RESULTS: A total of 20 patients received alternative DLC for respiratory failure. Cannula insertion sites included the left internal jugular vein (n = 5), the right (n = 7) or left (n = 3) subclavian vein and the right (n = 4) or left (n = 1) femoral vein. The median cannula size was 26 (19-28) French. The median initial target ECMO flow was 2.9 (1.8-3.1) l/min and corresponded with used cannula size and estimated cardiac output. No procedural complications were reported during cannulation and median ECMO runtime was 15 (9-22) days. Ten patients were successfully bridged to lung transplantation (n = 5) or lung recovery (n = 5). Ten patients died during or after ECMO support.
CONCLUSIONS: Alternative venous access sites for single-site dual-lumen catheters are a safe and feasible option to provide veno-venous ECMO support to patients with inaccessible RIJV.
摘要：
目的：用于静脉-静脉（VV）体外膜氧合（ECMO）支持的双腔插管通常插入右颈内静脉（RIJV），然而，有些情况下可能会使这种静脉路径无法进入。此多中心病例系列旨在评估在无法进入RIJV的患者中使用替代静脉通路进行单部位插管是否安全可行。
方法：我们进行了一项多机构回顾性分析，包括在双腔插管（DLC）（定义为每年>10DLC）方面有丰富经验的高容量ECMO中心。三个中心((弗莱堡(德国)，多伦多（加拿大）和维也纳（奥地利）同意分享他们的数据，包括基线特征，技术ECMO和插管数据以及与ECMO插管和结果相关的并发症。
结果：共有20例患者接受了呼吸衰竭的替代DLC。套管插入部位包括左颈内静脉（n=5），右（n=7）或左（n=3）锁骨下静脉和右（n=4）或左（n=1）股静脉。套管尺寸的中位数为26（19-28）法国。初始目标ECMO流量中位数为2.9（1.8-3.1）L/min，与使用的套管大小和估计的心输出量相对应。插管期间未报告手术并发症，ECMO运行时间中位数为15（9-22）天。10例患者成功桥接肺移植（n=5）或肺恢复（n=5）。10名患者在ECMO支持期间或之后死亡。
结论：单部位双腔导管的替代静脉通路是一种安全可行的选择，可以为无法进入RIJV的患者提供VV-ECMO支持。
方法：我们进行了一项多机构回顾性分析，包括在双腔插管（DLC）（定义为每年>10DLC）方面有丰富经验的高容量ECMO中心。三个中心((弗莱堡(德国)，多伦多（加拿大）和维也纳（奥地利）同意分享他们的数据，包括基线特征，技术ECMO和插管数据以及与ECMO插管和结果相关的并发症。
结果：共有20例患者接受了呼吸衰竭的替代DLC。套管插入部位包括左颈内静脉（n=5），右（n=7）或左（n=3）锁骨下静脉和右（n=4）或左（n=1）股静脉。套管尺寸的中位数为26（19-28）法国。初始目标ECMO流量中位数为2.9（1.8-3.1）L/min，与使用的套管大小和估计的心输出量相对应。插管期间未报告手术并发症，ECMO运行时间中位数为15（9-22）天。10例患者成功桥接肺移植（n=5）或肺恢复（n=5）。10名患者在ECMO支持期间或之后死亡。
结论：单部位双腔导管的替代静脉通路是一种安全可行的选择，可以为无法进入RIJV的患者提供VV-ECMO支持。
