Analyzing The Efficacy Of Extracorporeal Membrane Oxygenation Support In Patients With Refractory Hypoxemia After Cardiac Surgery

Objective:To investigate the therapeutic effects of veno-venous extracorporeal membrane oxygenation（V-V ECMO）in patients with refractory hypoxemia（RH）after cardiopulmonary bypass（CPB）by analyzing the clinical data of patients who received V-V ECMO and those who did not.Methods:The clinical data of RH patients with indications for V-V ECMO after cardiac CPB were admitted to the Intensive Care Unit（ICU）of the First Affiliated Hospital of Xinjiang Medical University from January 2018to July 2022 were retrospectively analyzed.The patients were divided into the V-V ECMO treatment group and the conventional treatment group according to whether they received V-V ECMO support or not.The ventilator parameters,oxygenation index,heart rate,mean arterial pressure,and vasoactive drug index of patients in the V-V ECMO treatment group were compared before and 24 hours after V-V ECMO support.The incidence of postoperative complications,duration of mechanical ventilation,length of ICU stay,and in-hospital mortality were compared between the two groups.Results:A total of 65patients were enrolled in this study,including 30 patients in the V-V ECMO group,aged33 to 68（54.0±7.7）years,and 35 patients in the conventional treatment group,aged 38 to69（57.6±8.0）years.Compared with the patients in the V-V ECMO group before and 24hours after V-V ECMO support,the ventilator oxygen concentration（Fi O₂）,positive end-expiratory pressure（PEEP）,driving pressure,plateau pressure,lactic acid value and vasoactive drug index were significantly decreased（P<0.05）.The arterial partial pressure of oxygen（Pa O₂）and oxygenation index increased significantly（P<0.05）.Compared with the patients in the V-V ECMO group before and 24 hours after V-V ECMO support,the ventilator oxygen concentration（Fi O₂）,positive end-expiratory pressure（PEEP）,driving pressure,plateau pressure,lactic acid value,heart rate and vasoactive drug index were significantly decreased（P<0.05）.The arterial partial pressure of oxygen（Pa O₂）,mean arterial pressure and oxygenation index increased significantly（P<0.05）.There were no significant differences in baseline characteristics such as age,gender,type of surgery,and ventilator parameters between the V-V ECMO treatment group and the conventional treatment group（P>0.05）.Compared with the conventional treatment group,the incidence of arrhythmia,the duration of intra-aortic balloon pump（IABP）treatment,the duration of mechanical ventilation,the length of ICU stay and in-hospital mortality in the V-V ECMO treatment group were significantly decreased（P<0.05）,and the incidence of bleeding complications was significantly increased,the difference was statistically significant（P<0.05）.Conclusion:V-V ECMO is an effective support for the treatment of RH after CPB,which can rapidly improve oxygenation,reduce ventilator support conditions,and facilitate the implementation of a lung protective ventilation strategy.When the body’s hypoxia is corrected,the hemodynamics is gradually stabilized.Compared with conventional treatment,V-V ECMO support is more conducive to the recovery of the disease,promotes weaning,and reduces mortality,but it also brings more risk of bleeding.V-V ECMO should be applied as soon as possible after the patient meets the indications for V-V ECMO.The management of ECMO and the prevention and treatment of complications are the keys to successful treatment.