Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study
Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study
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DOI：
10.1186/cc12681
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发表时间：
2013-01-01
期刊：
影响因子：
15.1
通讯作者：
Pellegrino, Vince
中科院分区：
文献类型：
--
作者：
Aubron, Cecile;Cheng, Allen C.;Pellegrino, Vince
前言：体外膜肺氧合(ECMO)患者的死亡率居高不下。本研究的目的是评估在大型ECMO转诊中心接受ECMO的患者预后的相关因素，并比较静脉-动脉ECMO(VA ECMO)和静脉-静脉ECMO(VV ECMO)。方法：我们回顾了2005年1月至2011年6月前瞻性获得的ECMO数据库和患者的医疗记录。记录患者的人口学特征、入院时的病情严重程度、ECMO适应症、ECMO前的器官衰竭评分以及ECMO的模式和配置。还收集了ECMO中发生的出血、神经、血管和感染并发症。分析患者的人口学、疾病、ECMO支持因素和并发症与住院死亡率的关系。结果：151例患者共启动ECMO 158次。Va ECMO的发生率(66.5%)是VV ECMO的两倍(33.5%)，中位持续时间明显短于VV ECMO(7天(第一和第三四分位数：5；10天)和10天(第一和第三四分位数：6；16天))。ECMO支持期间最常见的并发症是出血和血液感染，无论是哪种ECMO类型。各ECMO组均成功脱机70%以上的ECMO发作。总死亡率为37.3%(VA ECMO组为37.1%，VV ECMO组为37.7%)。结论：在ECMO中发生的神经系统、血管、感染和出血事件中，出血是最常见的，并且对死亡率有显著影响。需要进一步的研究来更好地调查这些患者的出血和凝血障碍。减少这些并发症的干预可能会改善结果。
Introduction: Mortality of patients on extracorporeal membrane oxygenation (ECMO) remains high. The objectives of this study were to assess the factors associated with outcome of patients undergoing ECMO in a large ECMO referral centre and to compare veno-arterial ECMO (VA ECMO) with veno-venous ECMO (VV ECMO).Methods: We reviewed a prospectively obtained ECMO database and patients' medical records between January 2005 and June 2011. Demographic characteristics, illness severity at admission, ECMO indication, organ failure scores before ECMO and the ECMO mode and configuration were recorded. Bleeding, neurological, vascular and infectious complications that occurred on ECMO were also collected. Demographic, illness, ECMO support descriptors and complications associated with hospital mortality were analysed.Results: ECMO was initiated 158 times in 151 patients. VA ECMO (66.5%) was twice as common as VV ECMO (33.5%) with a median duration significantly shorter than for VV ECMO (7 days (first and third quartiles: 5; 10 days) versus 10 days (first and third quartiles: 6; 16 days)). The most frequent complications during ECMO support were bleeding and bloodstream infections regardless of ECMO type. More than 70% of the ECMO episodes were successfully weaned in each ECMO group. The overall mortality was 37.3% (37.1% for the patients who underwent VA ECMO, and 37.7% for the patients who underwent VV ECMO). Haemorrhagic events, assessed by the total of red blood cell units received during ECMO, were associated with hospital mortality for both ECMO types.Conclusions: Among neurologic, vascular, infectious and bleeding events that occurred on ECMO, bleeding was the most frequent and had a significant impact on mortality. Further studies are needed to better investigate bleeding and coagulopathy in these patients. Interventions that reduce these complications may improve outcome.