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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
Published on: October 24, 2018
Pressure injuries in patients receiving extracorporeal membrane oxygenation: a tertiary centre experience
Halide Oğuş1, A Ece Altınay1, Fatih Yiğit2
1Department of Anaesthesiology, University of Health Sciences, Koşuyolu High Specialization Training and Research Hospital, Istanbul, Turkey.
Insights
Pressure injuries (PIs) are common in intensive care patients on extracorporeal membrane oxygenation (ECMO). Age and ECMO duration are key risk factors for developing new PIs during treatment for COVID-19-associated ARDS.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Infectious Diseases
Background:
- Pressure injuries (PIs) are a significant concern for critically ill patients, particularly those requiring extracorporeal membrane oxygenation (ECMO).
- COVID-19-associated acute respiratory distress syndrome (ARDS) often necessitates prolonged ECMO support, increasing patient vulnerability to PIs.
Purpose of the Study:
- To determine the incidence and identify risk factors for pressure injuries (PIs) in patients receiving ECMO for COVID-19-associated ARDS.
Main Methods:
- A retrospective evaluation of 78 patients with severe COVID-19-associated ARDS receiving veno-venous ECMO between April 2020 and January 2022.
- PI risk was assessed using the Braden scale, and PI staging followed National Pressure Injury Advisory Panel guidelines.
- Patients were managed according to the 2019 clinical practice guidelines for pressure ulcer prevention and treatment.
Main Results:
- Of 78 patients, 30.8% had pre-existing PIs upon ICU transfer on ECMO.
- New PIs developed in 44.4% of patients (24/54) during a median ECMO duration of 48.5 days, primarily stage 2.
- Independent predictors for new PI development included advanced age (OR: 1.103) and longer ECMO duration (OR: 1.048).
Conclusions:
- Adherence to established clinical practice guidelines for PI prevention by a dedicated intensive care unit team is crucial.
- Implementing strict PI prevention protocols can significantly reduce the incidence of pressure injuries in patients on prolonged ECMO support.
Objective:
Pressure injuries (PIs) are common in patients receiving intensive care and extracorporeal membrane oxygenation (ECMO). This study assessed the incidence and risk factors of PIs in patients receiving ECMO for COVID-19-associated acute respiratory distress syndrome (ARDS).
Method:
Patients who were admitted to the intensive care unit (ICU) with severe COVID-19-associated ARDS and received veno-venous ECMO between April 2020 and January 2022 were evaluated. All patients were monitored, evaluated and managed according to the Prevention and treatment of pressure ulcers: clinical practice guideline 2019. The risk for PI was evaluated using the Braden scale. Staging of PIs was made according to the National Pressure Injury Advisory Panel guidelines.
Results:
A total of 78 patients (median age 45 years) received ICU care and ECMO support. Of these, 75 patients were transferred to the ICU while on ECMO support; 24/78 (30.8%) patients already had PIs. New PIs developed in 24 patients (24/54, 44.4%) during prolonged periods of ECMO (median 48.5 days). The new PIs were mainly stage 2 (55%). The median time to new PI development during ECMO was 21 (range 4-60) days. The mortality rate was 32/54 (59.3%). In multivariable analysis, age (odds ratio (OR): 1.103, 95% confidence interval (CI): 1.022, 1.191; p=0.027) and ECMO duration (OR: 1.048, 95% CI: 1.016, 1.081; p=0.003) were independent predictors of PI development.
Conclusion:
Strict compliance with the clinical practice guidelines for PIs by a dedicated ICU team may considerably reduce the incidence of PIs among patients receiving ECMO for prolonged periods.
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