背景:动员在重症监护病房(ICU)的较长疗程中很重要,通常是需要静脉体外膜氧合(V-VECMO)的患者。对于ECMO支持的患者,尤其是床下动员可以改善预后。我们假设,与单腔插管(SLC)相比,将双腔插管(DLC)用于V-VECMO将有助于床外动员。
方法:回顾性单中心注册研究,包括2010年10月至2021年5月期间因呼吸衰竭而插管的所有V-VECMO患者。
结果:注册包括355例V-VECMO患者(中位年龄55.6岁,31.8%女性,27.3%患有先前存在的肺部疾病),289/355(81.4%)用DLC和66/355(18.6%)使用SLC。两组的ECMO前特征相似。与SLC相比,DLC中第一个ECMO套管的运行时间明显更长(169vs.115h,p=0.015)。两组在V-VECMO期间俯卧位的频率相似(38.4vs.34.8%,p=0.673)。在床上动员方面没有差异(41.2与36.4%,对于DLC和SLC,分别,p=0.491)。DLC患者更常被动员下床(25.6vs.12.1%,或2.495(95%CI1.150至5.268),对于DLC和SLC,分别,p=0.023)。两组的医院生存率相似(46.4vs.39.4%,对于DLC和SLC,分别,p=0.339)结论:使用双腔套管进行V-VECMO支持的患者在床下活动的频率明显更高。由于动员在ECMO患者典型的长期ICU课程中很重要,这可能是一个重要的好处。DLC的其他益处是初始套管组的较长的运行时间和较少的抽吸事件。
BACKGROUND: Mobilization is important in longer courses in intensive care unit (ICU), typical for patients requiring venovenous extracorporeal membrane oxygenation (V-V ECMO). For patients supported with ECMO, especially out-of-bed mobilizations improve outcome. We hypothesized that utilization of a dual lumen cannula (DLC) for V-V ECMO would facilitate out-of-bed mobilization compared to single lumen cannulas (SLC).
METHODS: Retrospective single center registry study including all V-V ECMO patients cannulated between 10/2010 and 05/2021 for respiratory failure.
RESULTS: The registry included 355 V-V ECMO patients (median age 55.6 years, 31.8% female, 27.3% with preexisting pulmonary disease), 289/355 (81.4%) primary cannulated with DLC, and 66/355 (18.6%) using SLC. Both groups had similar pre-ECMO characteristics. The runtime of the first ECMO cannula was significantly longer in DLC compared to SLC (169 vs. 115 h, p = 0.015). The frequency of prone positioning during V-V ECMO was similar in both groups (38.4 vs. 34.8%, p = 0.673). There was no difference in in-bed mobilization (41.2 vs. 36.4%, for DLC and SLC, respectively, p = 0.491). Patients with DLC were more often mobilized out-of-bed (25.6 vs. 12.1%, OR 2.495 [95% CI 1.150 to 5.268], for DLC and SLC, respectively, p = 0.023). Hospital survival was similar in both groups (46.4 vs. 39.4%, for DLC and SLC, respectively, p = 0.339).
CONCLUSIONS: Patients cannulated with a dual lumen cannula for V-V ECMO support were significantly more often mobilized out-of-bed. Since mobilization is important in prolonged ICU courses typical for ECMO patients, this might be an important benefit. Other benefits of DLC were the longer runtime of the initial cannula set and fewer suction events.