体外膜肺氧合患者氧合器全流程管理方案的构建及可行性分析

doi:10.3761/j.issn.2096-7446.2026.03.002

Abstract

Abstract:

Objective To Construct a full-process management plan for oxygenators in patients undergoing ex-tracorporeal membrane oxygenation（ECMO） therapy，so as to provide a reference for clinical nursing.Methods The literature analysis method was adopted to construct a preliminary full-process management plan for oxygenators in ECMO patients. From November to December 2024，the Delphi method was used to conduct 2 rounds of correspondence consultation with 15 experts，and the final full-process management plan for oxygenators in ECMO patients was formed.Results The effective response rate of the expert consultation questionnaires in both rounds was 100%. The authority coefficients were 0.87 and 0.917 respectively. For the two rounds of expert consultation，the coefficient of variation for the importance of each item was 0-0.422 and 0-0.148，while the coefficient of variation for the feasibility of each item was 0-0.235 and 0-0.133 respectively. The Kendall’s concordance coefficient for importance was 0.178（χ²=101.102，P<0.001） and 0.212（χ²=158.536，P<0.001） in the two rounds，and the Kendall’s concordance coefficient for feasibility was 0.212（χ²=94.538，P<0.001） and 0.268（χ²=106.214，P<0.001） respectively. Eventually，a full-process management plan for oxygenators in ECMO patients，which included 6 dimensions and a total of 35 items，was formulated.Conclusion The full-process oxygenator management protocol for ECMO patients demonstrates high scientific rigor，reliability，and feasibility，serving as a valuable reference for clinical practitioners in optimizing ECMO oxygenator management.

Key words: Extracorporeal Membrane Oxygenation, Oxygenator, Delphi Method, Nursing Care

ZHANG Shuai, GAO Xin, QIAN Jiawei, WANG Xiao, SHEN Danping, LI Wenya, SHEN Xiulan. Construction and feasibility analysis of a full-process management program for oxygenators in patients undergoing extracorporeal membrane oxygenation therapy[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(3): 266-273.

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[1]	Schmidt M, Franchineau G, Combes A. Recent advances in venovenous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome[J]. Curr Opin Crit Care, 2019, 25(1):71-76. doi: 10.1097/MCC.0000000000000567 pmid: 30516588
[2]	Leerson J, Tulloh A, Lopez FT, et al. Detecting oxygenator thrombosis in ECMO:a review of current techniques and an exploration of future directions[J]. Semin Thromb Hemost, 2024, 50(2):253-270. doi: 10.1055/s-0043-1772843
[3]	Zakhary B, Vercaemst L, Mason P, et al. How I approach membrane lung dysfunction in patients receiving ECMO[J]. Crit Care, 2020, 24(1):671. doi: 10.1186/s13054-020-03388-2
[4]	Butt SP, Razzaq N, Saleem Y, et al. Improving ECMO therapy:Monitoring oxygenator functionality and identifying key indicators,factors,and considerations for changeout[J]. J Extra Corpor Technol, 2024, 56(1):20-29. doi: 10.1051/ject/2023047
[5]	Gajkowski EF, Herrera G, Hatton L, et al. ELSO guidelines for adult and pediatric extracorporeal membrane oxygenation circuits[J]. ASAIO J, 2022, 68(2):133-152. doi: 10.1097/MAT.0000000000001630 pmid: 35089258
[6]	Aokage T, Palmér K, Ichiba S, et al. Extracorporeal membrane oxygenation for acute respiratory distress syndrome[J]. J Inten-sive Care, 2015, 3:17.
[7]	国家卫生健康委员会. 《国家卫生健康委办公厅关于印发国家限制类技术目录和临床应用管理规范(2022年版)的通知》[EB/OL]. (2022)[2024-06-26]. http://www.nhc.gov.cn/yzygj/s7657/202204/2efe9f8ca13f499c8e1f70844fe96144.shtml.
	National Health Commission. Notice of the General Office of the National Health Commission on issuing the catalog of na-tional restricted technologies and the management specifications for clinical application(2022 Edition)[EB/OL]. (2022)[2024-06-26]. http://www.nhc.gov.cn/yzygj/s7657/202204/2efe9f8ca13f499c8e1f70844fe96144.shtml.
[8]	胡雁. 循证护理学[M]. 北京: 人民卫生出版社, 2012:130-141.
	Hu Y. Evidence-based nursing[M]. Beijing: People’s Medical Publishing House, 2012:130-141.
[9]	韦当, 王聪尧, 肖晓娟, 等. 指南研究与评价(AGREEⅡ)工具实例解读[J]. 中国循证儿科杂志, 2013, 8(4):316-319.
	Wei D, Wang CY, Xiao XJ, et al. Interpretation of the tools of AGREEⅡ[J]. Chin J Evid Based Pediatr, 2013, 8(4):316-319.
[10]	Gajkowski EF, Herrera G, Hatton L, et al. ELSO guidelines for adult and pediatric extracorporeal membrane oxygenation circuits[J]. ASAIO J, 2022, 68(2):133-152. doi: 10.1097/MAT.0000000000001630 pmid: 35089258
[11]	Helms J, Frere C, Thiele T, et al. Anticoagulation in adult patients supported with extracorporeal membrane oxygenation:guidance from the Scientific and Standardization Committees on Perioperative and Critical Care Haemostasis and Thrombosis of the International Society on Thrombosis and Haemostasis[J]. J Thromb Haemost, 2023, 21(2):373-396. doi: 10.1016/j.jtha.2022.11.014
[12]	Lv XC, Deng MJ, Wang L, et al. Low vs standardized dose anticoagulation regimens for extracorporeal membrane oxygenation:a meta-analysis[J]. PLoS One, 2021, 16(4):e0249854. doi: 10.1371/journal.pone.0249854
[13]	Chen JL, Chen GQ, Zhao WY, et al. Anticoagulation strategies in patients with extracorporeal membrane oxygenation:a net-work meta-analysis and systematic review[J]. Pharmacotherapy, 2023, 43(10):1084-1093. doi: 10.1002/phar.v43.10
[14]	Ait Hssain A, Vahedian-Azimi A, Ibrahim AS, et al. Incidence,risk factors and outcomes of nosocomial infection in adult patients supported by extracorporeal membrane oxygenation:a systematic review and meta-analysis[J]. Crit Care, 2024, 28(1):158. doi: 10.1186/s13054-024-04946-8
[15]	Saracoglu A, Fawzy I, Saracoglu KT, et al. Point of care guided coagulation management in adult patients on ECMO:a systematic review and meta-analysis[J]. J Crit Care, 2024, 83:154830. doi: 10.1016/j.jcrc.2024.154830
[16]	中国心胸血管麻醉学会,中华医学会麻醉学分会,中国医师协会麻醉学医师分会, 等. 不同情况下成人体外膜肺氧合临床应用专家共识(2020版)[J]. 中国循环杂志, 2020, 35(11):1052-1063.
	Chinese Cardiothoracic and et al. Vascular Anesthesiology Association,Anesthesiology Branch of Chinese Medical Association,Anesthesiologists Branch of Chinese Medical Doctor Association, Expert consensus on the clinical application of adult extracorporeal membrane oxygenation under different conditions(2020 edition)[J]. Chin Circ J, 2020, 35(11):1052-1063.
[17]	童洪杰, 邓鸿胜, 彭伟, 等. 成人体外膜氧合辅助期间感染防控专家共识[J]. 中国循环杂志, 2024, 39(3):209-216.
	Tong HJ, Deng HS, Peng W, et al. Expert consensus on the prevention and management of infection during extracorporeal membrane oxygenation in adult patients[J]. Chin Circ J, 2024, 39(3):209-216.
[18]	Lubnow M, Philipp A, Foltan M, et al. Technical complications during veno-venous extracorporeal membrane oxygenation and their relevance predicting a system-exchange:retrospective analysis of 265 cases[J]. PLoS One, 2014, 9(12):e112316. doi: 10.1371/journal.pone.0112316
[19]	Evans CF, Li TL, Mishra V, et al. Externally visible thrombus partially predicts internal thrombus deposition in extracorpo-real membrane oxygenators[J]. Perfusion, 2017, 32(4):301-305. doi: 10.1177/0267659116678679
[20]	Karagiannidis C, Strassmann S, Brodie D, et al. Impact of membrane lung surface area and blood flow on extracorporeal CO₂ removal during severe respiratory acidosis[J]. Intensive Care Med Exp, 2017, 5(1):34. doi: 10.1186/s40635-017-0147-0 pmid: 28766276
[21]	Umei N, Ichiba S, Genda Y, et al. Early predictors of oxygenator exchange during veno-venous extracorporeal membrane oxygenation:a retrospective analysis[J]. Int J Artif Organs, 2022, 45(11):927-935. doi: 10.1177/03913988221118382
[22]	Sarathy S, Turek JW, Chu J, et al. Flow monitoring of ECMO circuit for detecting oxygenator obstructions[J]. Ann Biomed Eng, 2021, 49(12):3636-3646. doi: 10.1007/s10439-021-02878-w pmid: 34705123
[23]	Figueroa Villalba CA, McMullan DM, Reed RC, et al. Thrombosis in extracorporeal membrane oxygenation(ECMO) circuits[J]. ASAIO J, 2022, 68(8):1083-1092. doi: 10.1097/MAT.0000000000001605
[24]	Kaesler A, Hesselmann F, Zander MO, et al. Technical indicators to evaluate the degree of large clot formation inside the membrane fiber bundle of an oxygenator in an in vitro setup[J]. Artif Organs, 2019, 43(2):159-166. doi: 10.1111/aor.13343 pmid: 30084492
[25]	Belliato M, Degani A, Buffa A, et al. A brief clinical case of monitoring of oxygenator performance and patient-machine interdependency during prolonged veno-venous extracorporeal membrane oxygenation[J]. J Clin Monit Comput, 2017, 31(5):1027-1033. doi: 10.1007/s10877-016-9927-4 pmid: 27558734

Construction and feasibility analysis of a full-process management program for oxygenators in patients undergoing extracorporeal membrane oxygenation therapy

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