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.
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。