초록접수 현황
| 20F-145 | 구연 발표 |
Safety and efficacy of simple manual compression after removal of the percutaneous venoarterial extracorporeal membrane oxygenation
Hee Kyung Kim, Hyung Tae Sim, Min Seop Jo, Yong Jin Chang, Deog Gon Cho, Kyu Do Cho
Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, The Catholic University College of Medicine, Suwon, Gyeonggi-do, Republic of Korea
Purpose : The best method to remove percutaneous venoarterial extracorporeal membrane oxygenation (VA ECMO) has not yet been established. The use of closure devices can help reduce hemostasis time, but failure due to technical problems can lead to serious complications. Open surgery is an obvious way to repair blood vessels, but hematomas and bleeding make them difficult to repair. We sought to evaluate the results of simple manual compression without the use of closure devices after removal of the VA ECMO.
Methods : We analyzed 33 patients who were discharged from the hospital after successful weaning off from VA ECMO from January 2011 to July 2020. All patients underwent manual compression at intensive care unit (ICU) after removal of the VA ECMO. The ECMO insertion site was femoral artery and vein in all cases. CT angiography or ultrasound was performed in all patients before discharge to assess the presence of vascular complications. Twenty-seven patients underwent CT angiography and six patients underwent ultrasound.
Results : There was no initial hemostasis failure. Median compression time was 120 minutes (range 60 – 240 minutes). Median ECMO running time was 8 days (range 1 – 29 days). On CT angiography, abnormal findings were found in 8 patients. Five patients had pseudoaneurysms in the inserted femoral artery and three patients had thrombotic occlusion in the ipsilateral iliac artery. Pseudoaneurysms were treated with stent graft insertion in two patients and open surgical repair in three patients. Of the patients with occlusion of iliac artery, two underwent open surgical thrombectomy and one underwent femoral-femoral bypass. All procedures were successful without any complications. There were no significant risk factors for later vascular complications after ECMO removal.
Conclusion : Successful hemostasis was possible with only simple compression after removal of ECMO. Although late vascular complications were not uncommon, all complications could be managed successfully with timely surveillance and treatment. Simple manual compression is one of the safe and effective options for percutaneous VA ECMO removal.
Methods : We analyzed 33 patients who were discharged from the hospital after successful weaning off from VA ECMO from January 2011 to July 2020. All patients underwent manual compression at intensive care unit (ICU) after removal of the VA ECMO. The ECMO insertion site was femoral artery and vein in all cases. CT angiography or ultrasound was performed in all patients before discharge to assess the presence of vascular complications. Twenty-seven patients underwent CT angiography and six patients underwent ultrasound.
Results : There was no initial hemostasis failure. Median compression time was 120 minutes (range 60 – 240 minutes). Median ECMO running time was 8 days (range 1 – 29 days). On CT angiography, abnormal findings were found in 8 patients. Five patients had pseudoaneurysms in the inserted femoral artery and three patients had thrombotic occlusion in the ipsilateral iliac artery. Pseudoaneurysms were treated with stent graft insertion in two patients and open surgical repair in three patients. Of the patients with occlusion of iliac artery, two underwent open surgical thrombectomy and one underwent femoral-femoral bypass. All procedures were successful without any complications. There were no significant risk factors for later vascular complications after ECMO removal.
Conclusion : Successful hemostasis was possible with only simple compression after removal of ECMO. Although late vascular complications were not uncommon, all complications could be managed successfully with timely surveillance and treatment. Simple manual compression is one of the safe and effective options for percutaneous VA ECMO removal.
책임저자: Hyung Tae Sim
Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, The Catholic University College of Medicine, Suwon, Gyeonggi-do, Republic of Korea
발표자: Hee Kyung Kim, E-mail : sallykimkr@hanmail.net