Nima Djavidi, Samia Boussouar, Baptiste Duceau, Petra Bahroum, Simon Rivoal, Geoffroy Hariri, Aymeric Lancelot, Pauline Dureau, Ahmed Abbes, Edris Omar, Ahmed Charfeddine, Guillaume Lebreton, Alban Redheuil, Charles-Edouard Luyt, Adrien Bouglé
{"title":"静脉体外膜氧合支持术后的血管并发症：CT 研究。","authors":"Nima Djavidi, Samia Boussouar, Baptiste Duceau, Petra Bahroum, Simon Rivoal, Geoffroy Hariri, Aymeric Lancelot, Pauline Dureau, Ahmed Abbes, Edris Omar, Ahmed Charfeddine, Guillaume Lebreton, Alban Redheuil, Charles-Edouard Luyt, Adrien Bouglé","doi":"10.1097/CCM.0000000000006476","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Vascular complications after venoarterial extracorporeal membrane oxygenation (ECMO) remains poorly studied, although they may highly impact patient management after ECMO removal. Our aim was to assess their frequency, predictors, and management.</p><p><strong>Design: </strong>Retrospective, observational cohort study.</p><p><strong>Setting: </strong>Two ICUs from a tertiary referral academic hospital.</p><p><strong>Patients: </strong>Adult patients who were successfully weaned from venoarterial ECMO between January 2021 and January 2022.</p><p><strong>Interventions: </strong>None.</p><p><strong>Primary outcome: </strong>Vascular complications frequency related to ECMO cannula.</p><p><strong>Measurements and main results: </strong>A total of 288 patients were implanted with venoarterial ECMO during the inclusion period. One hundred ninety-four patients were successfully weaned, and 109 underwent a CT examination to assess for vascular complications until 4 days after the weaning procedure. The median age of the cohort was 58 years (interquartile range [IQR], 46-64 yr), with a median duration of ECMO support of 7 days (IQR, 5-12 d). Vascular complications were observed in 88 patients (81%). The most frequent complication was thrombosis, either cannula-associated deep vein thrombosis (CaDVT) (n = 63, 58%) or arterial thrombosis (n = 36, 33%). Nonthrombotic arterial complications were observed in 48 patients (44%), with 35 (31%) presenting with bleeding. The most common site of CaDVT was the inferior vena cava, occurring in 33 (50%) of cases, with 20% of patients presenting with pulmonary embolism. There was no association between thrombotic complications and ECMO duration, anticoagulation level, or ECMO rotation flow. CT scans influenced management in 83% of patients. In-hospital mortality was 17% regardless of vascular complications.</p><p><strong>Conclusions: </strong>Vascular complications related to venoarterial ECMO cannula are common after ECMO implantation. CT allows early detection of complications after weaning and impacts patient management. Patients should be routinely screened for vascular complications by CT after decannulation.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Vascular Complications After Venoarterial Extracorporeal Membrane Oxygenation Support: A CT Study.\",\"authors\":\"Nima Djavidi, Samia Boussouar, Baptiste Duceau, Petra Bahroum, Simon Rivoal, Geoffroy Hariri, Aymeric Lancelot, Pauline Dureau, Ahmed Abbes, Edris Omar, Ahmed Charfeddine, Guillaume Lebreton, Alban Redheuil, Charles-Edouard Luyt, Adrien Bouglé\",\"doi\":\"10.1097/CCM.0000000000006476\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Vascular complications after venoarterial extracorporeal membrane oxygenation (ECMO) remains poorly studied, although they may highly impact patient management after ECMO removal. Our aim was to assess their frequency, predictors, and management.</p><p><strong>Design: </strong>Retrospective, observational cohort study.</p><p><strong>Setting: </strong>Two ICUs from a tertiary referral academic hospital.</p><p><strong>Patients: </strong>Adult patients who were successfully weaned from venoarterial ECMO between January 2021 and January 2022.</p><p><strong>Interventions: </strong>None.</p><p><strong>Primary outcome: </strong>Vascular complications frequency related to ECMO cannula.</p><p><strong>Measurements and main results: </strong>A total of 288 patients were implanted with venoarterial ECMO during the inclusion period. One hundred ninety-four patients were successfully weaned, and 109 underwent a CT examination to assess for vascular complications until 4 days after the weaning procedure. The median age of the cohort was 58 years (interquartile range [IQR], 46-64 yr), with a median duration of ECMO support of 7 days (IQR, 5-12 d). Vascular complications were observed in 88 patients (81%). The most frequent complication was thrombosis, either cannula-associated deep vein thrombosis (CaDVT) (n = 63, 58%) or arterial thrombosis (n = 36, 33%). Nonthrombotic arterial complications were observed in 48 patients (44%), with 35 (31%) presenting with bleeding. The most common site of CaDVT was the inferior vena cava, occurring in 33 (50%) of cases, with 20% of patients presenting with pulmonary embolism. There was no association between thrombotic complications and ECMO duration, anticoagulation level, or ECMO rotation flow. CT scans influenced management in 83% of patients. In-hospital mortality was 17% regardless of vascular complications.</p><p><strong>Conclusions: </strong>Vascular complications related to venoarterial ECMO cannula are common after ECMO implantation. CT allows early detection of complications after weaning and impacts patient management. Patients should be routinely screened for vascular complications by CT after decannulation.</p>\",\"PeriodicalId\":10765,\"journal\":{\"name\":\"Critical Care Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":7.7000,\"publicationDate\":\"2024-11-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/CCM.0000000000006476\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/CCM.0000000000006476","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Vascular Complications After Venoarterial Extracorporeal Membrane Oxygenation Support: A CT Study.
Objectives: Vascular complications after venoarterial extracorporeal membrane oxygenation (ECMO) remains poorly studied, although they may highly impact patient management after ECMO removal. Our aim was to assess their frequency, predictors, and management.
Setting: Two ICUs from a tertiary referral academic hospital.
Patients: Adult patients who were successfully weaned from venoarterial ECMO between January 2021 and January 2022.
Interventions: None.
Primary outcome: Vascular complications frequency related to ECMO cannula.
Measurements and main results: A total of 288 patients were implanted with venoarterial ECMO during the inclusion period. One hundred ninety-four patients were successfully weaned, and 109 underwent a CT examination to assess for vascular complications until 4 days after the weaning procedure. The median age of the cohort was 58 years (interquartile range [IQR], 46-64 yr), with a median duration of ECMO support of 7 days (IQR, 5-12 d). Vascular complications were observed in 88 patients (81%). The most frequent complication was thrombosis, either cannula-associated deep vein thrombosis (CaDVT) (n = 63, 58%) or arterial thrombosis (n = 36, 33%). Nonthrombotic arterial complications were observed in 48 patients (44%), with 35 (31%) presenting with bleeding. The most common site of CaDVT was the inferior vena cava, occurring in 33 (50%) of cases, with 20% of patients presenting with pulmonary embolism. There was no association between thrombotic complications and ECMO duration, anticoagulation level, or ECMO rotation flow. CT scans influenced management in 83% of patients. In-hospital mortality was 17% regardless of vascular complications.
Conclusions: Vascular complications related to venoarterial ECMO cannula are common after ECMO implantation. CT allows early detection of complications after weaning and impacts patient management. Patients should be routinely screened for vascular complications by CT after decannulation.
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Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient.
Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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