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首页> 外文期刊>Artificial Organs >Distal Limb Perfusion: Achilles' Heel in Peripheral Venoarterial Extracorporeal Membrane Oxygenation
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Distal Limb Perfusion: Achilles' Heel in Peripheral Venoarterial Extracorporeal Membrane Oxygenation

机译：远端肢体灌注：周围静脉动脉体外膜氧合的跟腱

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摘要

Extracorporeal membrane oxygenation (ECMO) is a temporary mechanical circulatory assist method that offers circulatory as well as respiratory support efficiently via peripheral access; however, it is liable to complications. Limb ischemia is one of the notorious complications of ECMO but can be avoided utilizing a proper distal limb perfusion method. A retrospective study of patients undergoing peripheral venoarterial (VA) ECMO for various reasons between June 2010 and December 2012 was performed. All patients were evaluated by our multidisciplinary team for suitability as candidates for ECMO. A peripheral VA-ECMO circuit was implanted via groin: inflow cannula in the femoral vein, an outflow cannula and distal-perfusion cannula, or an introducer sheath in the femoral artery. During the study period, 83 patients underwent various types of ECMO; 45 received peripheral VA-ECMO. Distal limb perfusion was achieved with an introducer sheath (6-8Fr) in 13 cases and with a distal-perfusion cannula (10-12Fr) in 32 cases. Nine (20%) patients developed signs of ischemia; five (11.2%) were treated conservatively, while four (8.8%) required surgical intervention. One patient required a below-knee amputation. The incidences of limb ischemia and limb ischemia requiring surgical intervention were significantly higher for the introducer sheath compared with the cannula (30.6 vs. 15.6% and 15.4 vs. 6.25%, respectively). Moreover, the patients supported on ECMO with a distal-perfusion cannula spent a significantly longer time on ECMO compared with the ones in whom an introducer sheath was used (11.9 +/- 9.1 vs. 7.7 +/- 4.3 days). The mean cannula size was significantly greater than the mean introducer sheath size (11.1 +/- 1.3 vs. 7.0 +/- 1.1Fr). Use of a distal-perfusion cannula is a most reliable method of limb perfusion in peripheral VA-ECMO. The cannula can ensure adequate and smooth perfusion of the limb owing to its large caliber, its less turbulent flow, the ability it provides to monitor the flow, and the option to attach a side port.
机译：体外膜氧合（ECMO）是一种临时性的机械循环辅助方法，可通过外围通道有效地提供循环以及呼吸支持。但是，这容易引起并发症。肢体缺血是ECMO众所周知的并发症之一，但可以采用适当的远端肢体灌注方法避免。进行了一项回顾性研究，研究了从2010年6月至2012年12月因各种原因接受外周静脉（EC）ECMO的患者。我们的多学科团队评估了所有患者是否适合作为ECMO的候选人。通过腹股沟植入周围的VA-ECMO回路：股静脉的流入套管，流出的套管和远端灌注套管，或股动脉的导引鞘。在研究期间，有83名患者接受了各种类型的ECMO; 45个接收了外围VA-ECMO。用导引鞘（6-8Fr）进行远端肢体灌注13例，用远端灌注套管（10-12Fr）进行32例。九名（20％）患者出现缺血迹象; 5例（11.2％）接受了保守治疗，而4例（8.8％）需要手术干预。一名患者需要膝盖以下截肢术。与插管相比，导引鞘的肢体缺血和需要手术干预的肢体缺血的发生率显着更高（分别为30.6 vs. 15.6％和15.4 vs. 6.25％）。此外，与使用导引鞘的患者相比，使用远端灌注套管支持ECMO的患者在ECMO上花费的时间明显更长（11.9 +/- 9.1天与7.7 +/- 4.3天）。平均插管尺寸显着大于平均导管鞘尺寸（11.1 +/- 1.3与7.0 +/- 1.1Fr）。在远端VA-ECMO中使用远端灌注套管是最可靠的肢体灌注方法。插管的大口径，较少的湍流，提供的流量监测能力以及可选的侧边连接装置，可确保肢体的充分，顺畅的灌注。

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