在预先准备的体外膜氧化中无菌性和氧化器功能:一项前性临床研究
Daniel Bengtsson1, Bodil Jönsson2,3, Bengt Redfors4,5
1Department of Perfusion, Sahlgrenska University Hospital, Gothenburg, Sweden.
Resuscitation plus
|June 24, 2024
概括
长达57天的身体外膜氧化器 (ECMO) 电路的预先化是安全的,不会影响功能. 这种方法支持快速的体外心肺复苏 (ECPR) 启动,同时保持不育,尽管建议对非紧急病例保持谨慎.
科学领域:
- 心血管医学 心血管医学
- 医疗器械 医疗器械
- 关键护理医学 关键护理医学
背景情况:
- 尽量减少心脏骤停的持续时间对于体外心肺复苏 (ECPR) 至关重要.
- 预先准备的外体膜氧化器 (ECMO) 系统被用于缩短设置时间,但对其性能和无菌性的临床数据有限.
- 现有的预先准备的ECMO知识主要来自实验研究.
研究的目的:
- 在临床环境中使用干式和湿式预先制方法前性地研究氧化器的功能和无菌性.
- 评估湿式预先冲泡时间对氧化器性能和无菌性的影响.
- 评估预先准备的ECMO的可行性,以便快速启动ECPR.
主要方法:
- 在萨尔格伦斯卡大学医院进行了一项前性临床研究,涉及107个ECMO电路 (2019年10月 - 2021年12月).
- 电路最初是干,然后是湿,当前的电路在使用时.
- 通过培养原始溶液来评估无菌性,并使用线性混合模型在开始和治疗期间分析氧化器功能 (扫描气体流量,FiO2,电阻).
主要成果:
- 总设置时间的中位数为14天,湿时间的中位数为6天 (范围为0-57天).
- 在培养的105个电路中,103个是负面的;两个显示细菌生长 (凝血酶负型葡萄球菌和Cutibacterium acnes),发生率为1.9%.
- 湿时间没有显著影响初始氧化器功能. 在ECMO治疗期间,氧化器耐药性和FiO2增加,但这些变化与湿原始持续时间无关.
结论:
- 在长时间内 (长达57天) 进行ECMO电路的湿预,不会损害氧化器的功能.
- 细菌污染率低,这表明预先准备的ECMO系统通常保持不育,促进快速ECPR.
- 虽然预先培养是有效的,但在某些情况下,细菌生长需要在非紧急情况下保持谨慎,并建议在启动时进行例行培养.
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