Clinical application of prolonged ECMO life support strategy：single-center experience

doi:10.3877/cma.j.issn.2096-1537.2025.01.014

Abstract

Abstract:

Objective

To summarize the single-center experience，clarify its clinical prognosis and complications of piatients who received prolonged ECMO，and propose management strategies.

Methods

The date of 17 critically ill patients who received prolonged ECMO （≥14 days） life support in ICU of Peking Union Medical College Hospital from 2020 to 2023 were retrospectively analyzed，including their treatment strategies，ECMO-related complications，comorbidities，and survival prognosis.

Results

Of the 17 patients，14 received VV-ECMO and 3 received VA-ECMO. The Long-ECMO（Etiology-Coagulation-Multidisciplinary-Organ） management strategy was applied. The duration of ECMO support was 29 （24，34） days，with the longest duration being 88 days. Eleven patients received vasoactive drugs simultaneously，7 patients received CVVH treatment，and all 17 patients exhibited hemorrhagic complications，including 15 patients presenting with local hemorrhages at the ECMO catheterization site，3 patients developing thigh hematoma，13 patients experiencing nasal cavity bleeding，3 patients manifesting airway hemorrhages，2 patients with intracranial hemorrhages，and 3 patients displaying gastrointestinal bleeding. Five patients had positive blood cultures，and 4 patients had pneumothorax. Nine patients （52.9%） successfully withdrew from ECMO，and 8 patients survived during hospitalization （47.1%）.In the subgroup of 14 VV-ECMO patients，there was no difference in the ECMO support time and age between the survival group （7 cases） and the non-survival group （7 cases）［ECMO support time：（29.0±11.2） days vs（33.9±24.9） days，P=0.647； age：（65.6±6.9） years vs （69.6±14.5） years，P=0.522］. However，the baseline APACHE Ⅱ score in the non-survival group was significantly higher with statistically significant difference［（26.3±9.2） scores vs （14.6±1.9） scores，P=0.006］.

Conclusions

The prolonged ECMO management strategy can save the lives of critically ill patients. Attention should be paid to the prevention and treatment of complications and organ repair，and it also has certain application value in elderly patients.

Key words: Prolonged extracorporeal membrane oxygenation, Management strategy, Clinical experience

Siyi Yuan, Yun Long, Yi Chi, Longxiang Su, Wei Cheng, Hua Zhao, Wanglin Liu, Chaoji Zhang, Guotao Ma, Hui Huang, Huaiwu He. Clinical application of prolonged ECMO life support strategy：single-center experience[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2025, 11(01): 65-71.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2025.01.014

https://icu.cma-cmc.com.cn/EN/Y2025/V11/I01/65

Figures/Tables 4

参数	数值
男性［例（%）］	14（82.4）
年龄（岁， $\overset{ˉ}{x}$ ±s）	62.9±15.8
病因［例（%）］
COVID-19	7（41.2）
细菌性肺炎	4（23.5）
免疫病相关肺间质病变	3（17.6）
猝死（SLE 肺动脉高压、PE）	2（17.6）
右心肿瘤术后心功能抑制	1（5.9）
ECMO 上机时
氧合指数［mmHg，M（Q₂₅，Q₇₅）］	101.4（62.4，164.0）
PaCO₂（mmHg， $\overset{ˉ}{x}$ ±s）	56.3±21.4
PEEP（cmH₂O， $\overset{ˉ}{x}$ ±s）	9.5±1.8
APACHE Ⅱ（分， $\overset{ˉ}{x}$ ±s）	21.5±9.1
SOFA（分， $\overset{ˉ}{x}$ ±s）	10.6±2.1

参数	数值
男性［例（%）］	14（82.4）
年龄（岁， $\overset{ˉ}{x}$ ±s）	62.9±15.8
病因［例（%）］
COVID-19	7（41.2）
细菌性肺炎	4（23.5）
免疫病相关肺间质病变	3（17.6）
猝死（SLE 肺动脉高压、PE）	2（17.6）
右心肿瘤术后心功能抑制	1（5.9）
ECMO 上机时
氧合指数［mmHg，M（Q₂₅，Q₇₅）］	101.4（62.4，164.0）
PaCO₂（mmHg， $\overset{ˉ}{x}$ ±s）	56.3±21.4
PEEP（cmH₂O， $\overset{ˉ}{x}$ ±s）	9.5±1.8
APACHE Ⅱ（分， $\overset{ˉ}{x}$ ±s）	21.5±9.1
SOFA（分， $\overset{ˉ}{x}$ ±s）	10.6±2.1

基线资料	存活组（7 例）	非存活组（7 例）	统计值	P 值
年龄（岁）	65.6±6.9	69.6±14.5	t=0.66	0.522
男性［例（%）］	7（100.0）	5（71.4）	χ ²= 1.55	0.141
APACHE Ⅱ（收入当天）（分）	14.6±1.9	26.3±9.2	t=3.30	0.006
SOFA（收入当天）（分）	9.9±2.3	11.7±1.8	t=1.66	0.122
ECMO 支持时间（d）	29.0±11.2	33.9±24.9	t=0.47	0.647
气管插管到ECMO 时间（d）	4.6±5.3	5.3±4.7	t=0.27	0.794
呼吸衰竭到ECMO 时间（d）	10.3±8.3	11.7±7.8	t=0.33	0.746
ECMO 前基线
氧合指数（mmHg）	120.7±49.0	96.3±51.1	t=0.91	0.380
PEEP（cmH₂O）	9.0±1.3	10.6±1.4	t=1.87	0.086
PaCO₂（cmH₂O）	61.0±8.2	53.0±16.8	t=1.14	0.276

参数	存活组（7 例）	非存活组（7 例）	t 值	P 值
WBC（×10⁹/L）
D1	9.1±1.3	12.7±4.1	1.597	0.110
D7	9.1±6.0	8.4±3.0	0.703	0.482
D14	12.1±9.0	7.5±2.3	1.310	0.216
Ly#（×10⁹/L）
D1	0.38±0.17	0.55±0.45	0.768	0.442
D7	0.61±0.31	0.57±0.33	0.256	0.798
D14	0.55±0.27	0.62±0.39	0.128	0.898
PLT（×10⁹/L）
D1	103.4±48.4	134.6±73.9	0.703	0.482
D7	89.1±51.9	102.7±60.0	0.319	0.749
D14	125.1±88.3	94.7±29.1	0.193	0.847
Fbg（g/L）
D1	3.73±1.30	3.03±2.03	1.214	0.225
D7	3.08±1.23	2.34±0.69	1.469	0.142
D14	2.98±1.49	2.13±0.93	0.831	0.406
D-D（mg/L）
D1	5.3±3.8	14.5±14.1	1.469	0.142
D7	6.6±4.7	15.4±20.2	1.086	0.277
D14	14.0±14.1	18.2±14.1	0.319	0.749
PCT（ng/ml）
D1	4.48±10.38	0.50±0.60	0.858	0.391
D7	0.76±1.19	0.67±0.96	0.214	0.831
D14	0.64±0.48	0.30±0.31	1.654	0.098
Cr（μmol/L）
D1	71.4±21.4	57.7±20.4	0.958	0.338
D7	64.6±18.0	53.1±23.2	1.151	0.250
D14	77.4±63.3	48.4±16.5	1.154	0.249
Tb（μmol/L）
D1	15.3±16.6	12.3±3.9	1.151	0.250
D7	26.6±23.1	21.1±17.9	0.447	0.655
D14	20.2±17.2	33.9±49.0	0.575	0.565

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