Vascular Complications After Venoarterial Extracorporeal Membrane Oxygenation Support: A CT Study

被引：3

作者：

Djavidi, Nima ^{[1
]}

Boussouar, Samia ^{[2
]}

Duceau, Baptiste ^{[1
]}

Bahroum, Petra ^{[3
]}

Rivoal, Simon ^{[1
]}

Hariri, Geoffroy ^{[1
]}

Lancelot, Aymeric ^{[1
]}

Dureau, Pauline ^{[1
]}

Abbes, Ahmed ^{[1
]}

Omar, Edris ^{[1
]}

Charfeddine, Ahmed ^{[1
]}

Lebreton, Guillaume ^{[4
]}

Redheuil, Alban ^{[2
]}

Luyt, Charles-Edouard ^{[3
]}

Bougle, Adrien ^{[1
]}

机构：

[1] Sorbonne Univ, Hop Pitie Salpetriere, AP HP, Dept Anesthesie & Reanimat,Inst Cardiol, Paris, France

[2] Sorbonne Univ, Hop Pitie Salpetriere, AP HP, Unite Imagerie Cardiovasc & Thorac,Inst Cardiol, Paris, France

[3] Sorbonne Univ, Hop Pitie Salpetriere, AP HP, Serv Med Intens Reanimat,Inst Cardiol, Paris, France

[4] Sorbonne Univ, Hop Pitie Salpetriere, AP HP, Serv Chirurg Cardiaque,Inst Cardiol, Paris, France

来源：

CRITICAL CARE MEDICINE | 2025年 / 53卷 / 01期

关键词：

arterial thrombosis; computed tomography; deep vein thrombosis; extracorporeal membrane oxygenation; limb ischemia; pulmonary embolism; vascular complications; SUSPECTED PULMONARY-EMBOLISM; DEEP VENOUS THROMBOSIS; CARDIOGENIC-SHOCK; VEIN THROMBOSIS; PREVALENCE; GUIDELINES; MORTALITY; ADULT;

D O I：

10.1097/CCM.0000000000006476

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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.DESIGN:Retrospective, observational cohort study.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.

引用

页码：e96 / e108

页数：13

共 33 条

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