Association of bleeding and thrombosis with outcome in extracorporeal life support.
Association of bleeding and thrombosis with outcome in extracorporeal life support.
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DOI：
10.1097/pcc.0000000000000317
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发表时间：
2015-02
期刊：
影响因子：
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通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network
中科院分区：
文献类型：
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作者：
Dalton HJ;Garcia-Filion P;Holubkov R;Moler FW;Shanley T;Heidemann S;Meert K;Berg RA;Berger J;Carcillo J;Newth C;Harrison R;Doctor A;Rycus P;Dean JM;Jenkins T;Nicholson C;Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network
技术的变化和越来越多的体外生命支持（ECLS）在流感、心脏骤停和成人等患者人群中成功使用的报告正在导致ECLS的扩展。ECLS扩张的主要限制仍然是出血和血栓形成。这些并发症是死亡和发病的最常见原因。作为一个试点项目，提供基线数据，详细评估出血和血栓形成在当前的时代，ECLS患者进行了分析，从8个中心的尤尼斯肯尼迪施莱佛国家儿童健康和人类发展研究所（NICHD）合作儿科重症监护研究网络（CPCCRN）。回顾性分析了2005年至2011年期间来自8家CPCCRN中心的ELSO（体外生命支持组织登记处）报告的患者（<19岁）。研究队列包括2036例患者[13%患有先天性腹股沟疝（CDH）]。在非CDH患者队列中（n=1773），38%的患者发生出血，31%的患者发生血栓形成。出血和血栓形成与生存率下降相关，分别为40%（RR：0.59; 95%CI：0.53，0.66）和33%（OR 0.67; 95%CI：0.60，0.74）。ECLS持续时间较长和使用静脉动脉插管也与出血和/或血栓形成并发症的风险增加和生存率降低相关。最常见的出血事件包括手术部位出血（17%; n=306）、插管部位出血（14%; n=256）和颅内出血（11%; n=192）。常见的血栓形成事件是回路（15%; n=274）和氧合器（12%; n=212）中的凝块，以及溶血（血浆游离血红蛋白>50 mg/dL）（10%; n=177）。在CDH患者中，出血和血栓形成的发生率分别为45%（n=118）和60%（n=159）。出血事件与生存率降低相关（RR 0.62; 95%CI：0.46，0.86），而血栓形成事件与此无关（RR 0.92; 95%CI：0.67，1.26）。出血和血栓形成仍然是接受ECLS的患者的常见并发症。进一步研究减少或消除出血和血栓形成有助于改善患者预后。
Changes in technology and increased reports of successful extracorporeal life support (ECLS) use in patient populations such as influenza, cardiac arrest and adults are leading to expansion of ECLS. Major limitations to ECLS expansion remain bleeding and thrombosis. These complications are the most frequent causes of death and morbidity. As a pilot project to provide baseline data for a detailed evaluation of bleeding and thrombosis in the current era, ECLS patients were analyzed from eight centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN). Retrospective analysis of patients (<19 years) reported to the ELSO (Extracorporeal Life Support Organization registry from eight CPCCRN centers between 2005 and 2011. The study cohort consisted of 2036 patients [13% with congenital diaphragmatic hernia (CDH)]. none In the cohort of non-CDH patients (n=1773), bleeding occurred in 38% of patients while thrombosis was noted in 31%. Bleeding and thrombosis were associated with a decreased survival by 40% (RR: 0.59; 95%CI: 0.53, 0.66) and 33% (OR 0.67; 95%CI: 0.60, 0.74). Longer duration of ECLS and use of venoarterial cannulation were also associated with increased risk of bleeding and/or thrombotic complications and lower survival. The most common bleeding events included surgical site bleeding (17%; n=306), cannulation site bleeding (14%; n=256), and intracranial hemorrhage (11%; n=192). Common thrombotic events were clots in the circuit (15%; n=274) and the oxygenator (12%; n=212), and hemolysis (plasma free hemoglobin>50 mg/dL) (10%; n=177). Among patients with CDH, bleeding and thrombosis occurred in, respectively, 45% (n=118) and 60% (n=159), Bleeding events were associated with reduced survival (RR 0.62; 95%CI: 0.46, 0.86) although thrombotic events were not (RR 0.92; 95%CI: 0.67, 1.26). Bleeding and thrombosis remain common complications in patients undergoing ECLS. Further research to reduce or eliminate bleeding and thrombosis is indicated to help improve patient outcome.