Clinical Study On Complications Of Extracorporeal Membrane Oxygenation In Adults

1.Complications of venous arterial extracorporeal membrane oxygenation in adults and its effect on prognosisObjective: To summarize and analyze the complications of venous arterial extracorporeal membrane oxygenation(V-A ECMO)in adult patients with circulatory failure and the related factors of complications affecting the prognosis of adult patients.Method: To retrospectively summarize the data of adult patients with circulatory failure aged over 18 who underwent V-A ECMO therapy during period from January2010 to December 2020,and analyze the incidence of complications and the impact of different complications on adult patients with different diseases or primary diseases.Results: A total of 156 adult patients with V-A ECMO were included.The total weaning rate was 78.8%(123/156),and the survival rate was 55.1%(86/156).The survival rate was 93.8%(15/16)in low cardiac output group,29.8%(14/47)in ECPR group and 61.3%(57/93)in comprehensive group.The total complication rate was64.7%(101/156).The incidence of complications was as follows: 66 cases(42.3%)of intubation site bleeding,49 cases(31.4%)of membranous pulmonary thrombosis,31cases(19.9%)of multiple organ failure,29 cases(18.6%)of gastrointestinal bleeding,26 cases(16.7%)of infection,21 cases(13.5%)of renal insufficiency,11 cases(7.1%)of nervous system,11 cases(7.1%)of nasal hemorrhage,7 cases(4.5%)of pulmonary hemorrhage,4 cases(2.6%)of limb ischemia,and internal mammary artery hemorrhage 1 case(0.6%).The mortality was 100.0%(7/7)in intracranial hemorrhage,100.0%(7/7)in brain death,100.0%(4/4)in flow failure,74.2%(23/31)in multiple organ failure and 71.4%(5/7)in pulmonary hemorrhage.Conclusion: V-A ECMO can provide effective circulatory support for critically ill patients,and has a good effect for patients with low cardiac output after operation.The complications leading to the death of patients were nervous system diseases,flow failure,multiple organ failure and pulmonary hemorrhage.2.Complications of veno venous extracorporeal membrane oxygenation in adults and its effect on prognosisObjective: To analyze the complications and prognosis of intravenous extracorporeal membrane oxygenation(V-V ECMO)in the respiratory support of adult patients with severe pulmonary dysfunction,and summarize the risk factors affecting the process and prognosis of V-V ECMO,so as to improve the success rate of V-V ECMO in the treatment of patients with severe respiratory failure.Method: From January 2010 to December 2020,56 adult patients with severe respiratory failure who had no response to mechanical ventilation were retrospectively analyzed.The incidence,treatment methods and prognosis of related complications in the process of V-V ECMO respiratory support were analyzed,and the influence of related complications in the process of V-V ECMO on patients was analyzed.Results: All 56 patients were treated with V-V ECMO,55 patients were treated with right internal jugular vein-right femoral vein catheterization,and 1 patient was treated with right internal jugular-vein right femoral vein-left femoral vein catheterization.The duration of ECMO was 132.2±94.6(78-318h),and the duration of mechanical ventilation was 122.5±89.3(48-444h).Complications included 6 cases of bleeding at intubation site,4 cases of oxygenator plasma leakage,2 cases of pneumothorax,2cases of lower extremity deep venous thrombosis,and 2 cases of additional femoral vein intubation for drainage.There were 11 cases of multiple organ failure,3 cases of intracranial hemorrhage,1 case of ECMO replacement due to membranous pulmonary thrombosis.The incidence of mechanical complications was 53.6%,and the incidence of patient-related complications was 67.9%.47 patients with V-V ECMO were successfully weaned,the success rate of weaning was 83.9%(47/56).37 patients survived,the survival rate was 66.1%(37/56).Conclusion: For adult patients with severe respiratory failure,V-V ECMO can provide effective lung function support for patients,but in the process of V-V ECMO assistance,prevention of multiple organ failure,prevention of blood coagulation of pipeline and artificial lung,and prevention of plasma leakage of artificial lung are important indicators to ensure the prognosis of patients.The plasma leakage of membranous lung is the main feature of membranous lung failure.The replacement of membranous lung has an important impact on the survival and prognosis of patients.3.Analysis of complications of adult ECMO intra hospital and inter hospital transportationObjective: To analyze the complications of ECMO patients in the process of intra hospital and inter hospital transport,the transport methods and the impact of various accidents on the patients,so as to improve the clinical examination,diagnosis and treatment effect of ECMO patients,and provide practical experience for the inter hospital transport of severe patients.Method: From January 2010 to December 2020,the data of 22 patients who received ECMO in inter hospital transport and 69 patients who received ECMO in intra hospital transport for clinical examination were retrospectively summarized.The related complications and accidents in the process of inter hospital and intra hospital transportation were analyzed,and the influence of these factors on patients was summarized.Meanwhile,summarize the requirements of equipment,goods,personnel and vehicles in the process of ECMO transfer in intra hospital and inter hospital.Results: There were 22 cases of ECMO inter hospital transport,all of them were transported with ventilator,including 18 cases of V-V ECMO and 4 cases of V-A ECMO.The transfer distance is 12-125 km and the journey time is 21-207 min.There were 9 cases of complications in transit,the incidence rate was 40.9%(9/22).Complications included 2 cases of ECMO oxygen tube falling off,1 case of replacing oxygen bottle on the way,1 case of centrifugal pump stopping during transportation,2 cases of ECMO flow sharply decreasing,1 case of hypoxemia and 2 cases of ECMO tube discount.After emergency treatment,22 cases of related complications and accidents arrived at the hospital smoothly.9 cases died in the hospital,and the hospital mortality was 40.9%(9/22).69 cases were transferred in hospital,all of them were transported with ventilator,and the residence time outside the ward was 47-82 minutes.The incidence of accidents and complications was 62.3%(43/69).The main complications were mechanical complications and human factors.There were no death cases in intra hospital and inter hospital transportation.Conclusion: It is safe and feasible for critically ill patients to carry ventilator for inter hospital or intra hospital transport with the assistance of V-V ECMO or V-A ECMO.The main complications of inter hospital and intra hospital transport are mechanical complications and human factors.Therefore,we should pay attention to closely observe the indicators of patients and equipment,and timely find and deal with the related complications.4.The prognostic value of extravascular lung water index and pulmonary vascular permeability index in severe adult respiratory distress syndrome with extracorporeal membrane oxygenationObjective The purpose of this study was to investigate the impact of pulse index continuous cardiac output(Pi CCO)-based measurements in severe adult respiratory distress syndrome(ARDS)undergoing extracorporeal membrane oxygenation(ECMO)and screened parameters with favorable performance for predicting survival to discharge.Methods We retrospectively analyzed a total of 30 consecutive candidates who fulfilled the study entry criteria between January 2008 and December 2018.Detailed clinical data,including the parameters ECMO and respiratory setting,Pi CCO-based serial measurements were collected and compared among in-hospital survivors(n=18)and nonsurvivors(n=12).Results Extravascular lung water index(ELWI)and pulmonary vascular permeability index(PVPI)in non-survival group were significantly higher than survival group in five time points of 0,24 h,48h and a week after the monitoring is established and reached intergroup significant difference by 72h[(17.3±4.5)ml/kg vs(10.7±3.7)ml/kg,P=0.006;(3.4±1.2)ml/kg vs(2.3±0.6)ml/kg,P=0.008,respectively] and 1 week[(14.3±4.0)ml/kg vs(9.1±2.9)ml/kg,P=0.027;(2.6±0.8)ml/kg vs(2.0±0.6)ml/kg,P=0.041,respectively].In parallel to the course of ARDS,only the evolution of ELWI revealed statistically significant in the total(P-trend=0.003)and survivors group(P-trend<0.001).Spearman univariate correlation analysis showed that ELWI at72 h was significantly correlated with survival to discharge(r=-0.632,P=0.015).The receiver operating characteristic(ROC)curve analysis showed that ELWI by 72 h had the best discriminate performance in predicting survival with an area under the curve(AUC)of 0.900(95% Confidence interval[CI],0.699 to 1.101,P=0.043).The optimal cutoff value was 12.5 ml/kg,showed 100.0% sensitivity and 70.0%specificity.The observed cumulative survival was much higher for the group with ELWI less than 12.5ml/kg at 72 h compared with the group with ELWI greater than12.5ml/kg at 72h(log-rank test,P=0.022).Conclusions Pi CCO can be used for volume monitoring during ECMO assistance in severe ARDS patients.ELWI and PVPI at 72 h after Pi CCO establishment may facilitate to predict their intra-hospital survival.The former,with an optimal cutoff value of 12.5 ml/kg,possesses the best predictive value for intra-hospital and long-term survival.