Ekstrakorporeal Membran Oksijenasyon Tedavisi İçin Perkütan ve Yan Greft Perfüzyon Tekniklerinin Karşılaştırılması; Tek Merkez Deneyimi

Öz

Amaç: Ekstrakorporeal Membran Oksijenasyonu ECMO kullanımı, ciddi solunum ya da kalp yetmezliği olan, kritik hipoksik hastaların desteklenmesi için kabul gören bir teknoloji haline gelmiştir. ECMO desteği santral veya periferik kanülasyon ile yapılabilir. Santral kanülasyon, kardiyotomi sonrası hastalar için halen iyi bir seçenek olarak kalırken, Seldinger tekniği ile periferik kanülasyon, yoğun bakım ünitesinde herhangi bir cerrahi operasyona gerek duyulmadan yapılabilir. Merkezlerin, kanüle edilmiş ekstremitenin kanaması veya iskemi gibi komplikasyonları önlemek için kendi teknikleri vardır. Çalışmanın amacı, kanülasyon yerlerinde iskemi ve kanamadan kaçınma açısından iki kanülasyon tekniği, yan greft ve perkütan kanülasyonun karşılaştırılmasıdır.Gereç ve Yöntemler: Periferik venoarteriyel ECMO tedavisine alınan 19 hasta perfüzyon tekniğine göre iki gruba ayrıldı; Perkütan femoral arter kanülasyonu n = 10 ve yan greft perfüzyonu n = 9 . Hastalar gelişen komplikasyonlar açısından analiz edildi.Bulgular: PTFE greft grubunda yedi hastanın kanülasyon yerinden kanaması vardı, ancak direkt kanülasyon grubunda hiçbir hastada aynı komplikasyon gelişmedi. P

Anahtar Kelimeler

• Ekstrakorporel membran oksijenasyonu, Kateterizasyon, Vasküler greftleme

Percutaneous versus Side Graft Perfusion for Peripheral Extracorporeal Membrane Oxygenation Therapy; A Single Center Experience

Abstract

Objective: Extracorporeal Membrane Oxygenation ECMO usage, as a technology for the support of critically hypoxic patients, has become a widely accepted therapy for severe respiratory or cardiac failure. ECMO support can be performed by central or peripheral cannulation. Central cannulation still remains a good option for post cardiotomy patients, while peripheral cannulation with the Seldinger technique is feasible in the intensive care unit without any need of surgical exploration. Different centers have their own techniques to avoid complications like bleeding or ischemia of the cannulated extremity. The objective of this study was to compare two cannulation techniques, sidegraft and percutaneous cannulations, in terms of avoiding ischemia and bleeding at the cannulation sites.Material and Methods: Nineteen patients who received peripheral venoarterial ECMO were divided into two groups according to their perfusion technique; percutaneous femoral artery cannulation n=10 and side-graft perfusion. n=9 . The patients were analysed for complication development.Results: Seven of the 9 patients had bleeding from the cannulation site in the PTFE graft group, while none of the patients had same complication in the direct cannulation group. p

Keywords

• Extracorporeal membrane oxygenation, Catheterization, Vascular grafting

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