Clinical outcomes according to cannula configurations in patients with acute respiratory distress syndrome under veno-venous extracorporeal membrane oxygenation: a Korean multicenter study

Annals of Intensive Care

Chi Ryang Chung¹  Kyeongman Jeon¹  Woo Hyun Cho²  Sang-Bum Hong³  Young-Jae Cho⁴  Sung Yoon Lim⁴  Sang-Min Lee⁵  Sunghoon Park⁶  Soyeon Ahn⁷ 

[1] Department of Critical Care Medicine, Samsung Medical Center;Department of Internal Medicine, Pusan National University Yangsan Hospital;Department of Pulmonary and Critical Care Medicine, Asan Medical Center;Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital;Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital;Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital;Medical Research Collaborating Center, Seoul National University Bundang Hospital;

关键词: Acute respiratory distress syndrome;    PaO2;    Recirculation;    Veno-venous extracorporeal membrane oxygenation;    Complications;   

DOI  :  10.1186/s13613-020-00700-9

来源: DOAJ

【 摘 要 】

Abstract Background Recirculation during veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a known drawback that limits sufficient oxygenation. This study aimed to compare the short-term oxygenation and long-term mortality based on cannula configuration in patients with acute respiratory distress syndrome (ARDS) who receive VV-ECMO, especially in the absence of newly developed dual-lumen, single cannula. Methods Data of patients with severe ARDS who received VV-ECMO from 2012 to 2015 at six hospitals were retrospectively analyzed. Primary outcomes were the partial pressure of oxygen (PaO2) at 1, 4, and 12 h after ECMO initiation and 180-day mortality. Results Patients (n = 335) were divided into two groups based on the return cannula site: femoral vein (n = 178) or internal jugular vein (n = 157). The propensity score matching analysis generated 90 pairs, and baseline characteristics at admission, including PaO2, were similar between the groups. PaO2 at 1, 4 and 12 h after ECMO initiation were not different according to cannula configuration. Moreover, the increment in oxygenation from the baseline values was not different between the femoral and jugular group. PaCO2 level at 1, 4 and 12 h were significantly lower in the jugular group. The two groups did not differ in terms of mortality at 180 days after ECMO, however more cannula-related complications occurred in the jugular group. Conclusion Regardless of the cannula configuration, patients with ARDS managed with VV-ECMO showed comparable clinical outcomes in terms of short-term oxygenation and long-term mortality. Nevertheless, further well-designed randomized control trials are warranted.

【 授权许可】

Unknown