Clinical outcomes according to cannula confgurations in patients with acute respiratory distress syndrome under veno-venous extracorporeal membrane oxygenation: a Korean multicenter study / Sung Yoon Lim, Soyeon Ahn, Sang‑Bum Hong, Chi Ryang Chung, Kyeongman Jeon, Sang‑Min Lee, Woo Hyun Cho, Sunghoon Park and Young‑Jae Cho

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Background: Recirculation during veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a known drawback that limits sufcient oxygenation. This study aimed to compare the short-term oxygenation and long-term mortality based on cannula confguration in patients with acute respiratory distress syndrome (ARDS) who receive VV-ECMO, especially in the absence of newly developed dual-lumen, single cannula.
Methods: Data of patients with severe ARDS who received VV-ECMO from 2012 to 2015 at six hospitals were retro‑spectively analyzed. Primary outcomes were the partial pressure of oxygen (PaO2) at 1, 4, and 12 h after ECMO initia‑tion and 180-day mortality.
Results: Patients (n=335) were divided into two groups based on the return cannula site: femoral vein (n=178) or internal jugular vein (n=157). The propensity score matching analysis generated 90 pairs, and baseline characteristics at admission, including PaO2, were similar between the groups. PaO2 at 1, 4 and 12 h after ECMO initiation were not diferent according to cannula confguration. Moreover, the increment in oxygenation from the baseline values was not diferent between the femoral and jugular group. PaCO2 level at 1, 4 and 12 h were signifcantly lower in the jugu‑lar group. The two groups did not difer in terms of mortality at 180 days after ECMO, however more cannula-related complications occurred in the jugular group.
Conclusion: Regardless of the cannula confguration, patients with ARDS managed with VV-ECMO showed com‑parable clinical outcomes in terms of short-term oxygenation and long-term mortality. Nevertheless, further welldesigned randomized control trials are warranted.