A comparative research of effect on inserting a distal perfusion catheter and preventive insertion of a distal perfusion catheter based on the limb ischemia risk assessment table in patients with extracorporeal membrane oxygenation / 中华危重病急救医学

ABSTRACT

Objective:To compare the treatment effect of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients in the prophylactic distal perfusion catheter (DPC) and the non-prophylactic DPC.Methods:A prospective randomized controlled trial (RCT) was conducted. Patients who received VA-ECMO treatment were reviewed at Affiliated Jinhua Hospital, Zhejiang University School of Medicine from January 2019 to June 2020 were divided into two groups, the prophylactic DPC group (DPC placed immediately after the patient VA-ECMO) and the non-prophylactic DPC group (the DPC was placed after the early limb ischemic signs by using evaluation of the lower extremity perfusion assessment table). Comparing the differences of clinical data of two group patients. Pearson correlation analysis was used to analyze the correlation between peak velocity of dorsalis pedis artery and peak velocity of posterior tibial artery and transcutaneous oxygen partial pressure (TcPO 2). Results:A total of 62 patients were included in the analysis, with 31 cases in prophylactic DPC group and another 31 cases in non-prophylactic DPC group. There were no significant differences in sex, age, body mass index (BMI), smoking index, underlying disease, catheterization site, recovery time before on machine, extracorporeal membrane oxygenation (ECMO) operation time, mechanical ventilation time, length of stay in intensive care unit (ICU), mortality rate in hospital, and acute physiology and chronic health evaluationⅡ(APACHEⅡ) between the preventive DPC group and the non-preventive DPC group. There was no significant difference in ECMO indications, ECMO intubation location and pipeline type. The bleeding in the non-prophylactic DPC group was lower than that in the non-prophylactic DPC group [6.5% (2/31) vs. 29.0% (9/31), P < 0.05]. There were no significant differences in limb complications such as cyanosis, necrosis, amputation, compartment syndrome, arterial thrombosis, vascular reconstruction and repair, pseudoaneurysm, limb ischemic or limb infection. During the ECMO operation, except the blood stream infection in the non-prophylactic DPC group was lower than that in the non-prophylactic DPC group [3.2%(1/31) vs. 19.4% (6/31), P < 0.05], there was no other statistical difference in complications between the two groups. The peak velocity of dorsalis pedis artery in the preventive DPC group was significantly higher than that of the non-preventive DPC group (cm/s 19.30±10.85 vs. 17.85±8.55, P < 0.05), and the peak velocity of posterior tibial artery was significantly lower than that of the non-preventive DPC group (cm/s 19.90±10.94 vs. 21.58±9.77, P < 0.05). Pearson correlation analysis showed that the peak velocity of dorsalis pedis artery and peak velocity of posterior tibial artery of the preventive DPC group and the non-preventive DPC group were positively correlated with TcPO 2 ( r values were 0.747, 0.856, 0.850, 0.813, respectively, and P values were all 0.000). Conclusions:For patients with VA-ECMO treatment, the incidence of blood stream infection and bleeding during ECMO operation in non-prophylactic DPC implantation patients is lower than that of prophylactic DPC implantation patients. TcPO 2 is positively correlated with peak velocity of posterior tibial artery and dorsal foot artery in the cannulated limb. In patients with VA-ECMO undergoing femoral artery and vein puncture, in addition to judging the blood supply of lower limbs according to symptoms and signs, ultrasound and TcPO 2 monitoring can also be used as effective monitoring methods.