OBJECTIVES: 

Despite increasing use and promising outcomes, venovenous extracorporeal membrane oxygenation (V-V ECMO) introduces the risk of a number of complications across the spectrum of ECMO care. This narrative review describes the variety of short- and long-term complications that can occur during treatment with ECMO and how patient selection and management decisions may influence the risk of these complications.

DATA SOURCES: 

English language articles were identified in PubMed using phrases related to V-V ECMO, acute respiratory distress syndrome, severe respiratory failure, and complications.

STUDY SELECTION: 

Original research, review articles, commentaries, and published guidelines from the Extracorporeal Life support Organization were considered.

DATA EXTRACTION: 

Data from relevant literature were identified, reviewed, and integrated into a concise narrative review.

DATA SYNTHESIS: 

Selecting patients for V-V ECMO exposes the patient to a number of complications. Adequate knowledge of these risks is needed to weigh them against the anticipated benefit of treatment. Timing of ECMO initiation and transfer to centers capable of providing ECMO affect patient outcomes. Choosing a configuration that insufficiently addresses the patient’s physiologic deficit leads to consequences of inadequate physiologic support. Suboptimal mechanical ventilator management during ECMO may lead to worsening lung injury, delayed lung recovery, or ventilator-associated pneumonia. Premature decannulation from ECMO as lungs recover can lead to clinical worsening, and delayed decannulation can prolong exposure to complications unnecessarily. Short-term complications include bleeding, thrombosis, and hemolysis, renal and neurologic injury, concomitant infections, and technical and mechanical problems. Long-term complications reflect the physical, functional, and neurologic sequelae of critical illness. ECMO can introduce ethical and emotional challenges, particularly when bridging strategies fail.

CONCLUSIONS: 

V-V ECMO is associated with a number of complications. ECMO selection, timing of initiation, and management decisions impact the presence and severity of these potential harms.

中文翻译：

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与静脉体外膜氧合相关的并发症——会出现什么问题？

目标： 

尽管越来越多的使用和有希望的结果，但静脉体外膜肺氧合(VV ECMO) 在 ECMO 护理的范围内引入了许多并发症的风险。这篇叙述性综述描述了 ECMO 治疗期间可能发生的各种短期和长期并发症，以及患者选择和管理决策如何影响这些并发症的风险。

数据源： 

在 PubMed 中使用与 VV ECMO、急性呼吸窘迫综合征、严重呼吸衰竭和并发症相关的短语来识别英语文章。

研究选择： 

考虑了体外生命支持组织的原始研究、评论文章、评论和已发布的指南。

数据提取： 

来自相关文献的数据被识别、审查并整合成简明的叙述性审查。

数据综合： 

选择 VV ECMO 患者会使患者面临许多并发症。需要对这些风险有足够的了解，以权衡它们与治疗的预期益处。ECMO 启动和转移到能够提供 ECMO 的中心的时间会影响患者的预后。选择不能充分解决患者生理缺陷的配置会导致生理支持不足的后果。ECMO 期间不理想的机械呼吸机管理可能导致肺损伤恶化、肺恢复延迟或呼吸机相关性肺炎。在肺部恢复时从 ECMO 过早拔管会导致临床恶化，延迟拔管会不必要地延长并发症的暴露时间。短期并发症包括出血、血栓形成和溶血、肾脏和神经损伤、伴随感染，以及技术和机械问题。长期并发症反映了危重疾病的身体、功能和神经系统后遗症。ECMO 可能带来伦理和情感上的挑战，尤其是当桥接策略失败时。

结论： 

VV ECMO 与许多并发症有关。ECMO 的选择、启动时间和管理决策会影响这些潜在危害的存在和严重程度。