Longitudinal Trends in Bleeding Complications on Extracorporeal Life Support Over the Past Two Decades-Extracorporeal Life Support Organization Registry Analysis.
Longitudinal Trends in Bleeding Complications on Extracorporeal Life Support Over the Past Two Decades-Extracorporeal Life Support Organization Registry Analysis.
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DOI：
10.1097/ccm.0000000000005466
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发表时间：
2022-06-01
影响因子：
8.8
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中科院分区：
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关于体外生命支持 (ECLS) 期间出血并发症的院内结局数据的研究很少。回顾性观察研究。患者在体外生命支持组织 (ELSO) 登记处报告。 2000年1月1日至2020年3月31日期间，53.644名成年患者（≥18岁）的数据平均年龄为51.4±15.9岁，其中33.859名（64.5%）男性接受单一ECLS支持，其中19.748名插管接受V-V ECLS，30.696名接受V-A ECLS。出血并发症、出血危险因素和死亡率的趋势。 14.786 名患者（27.6%）报告了出血并发症；与 V-V 相比，V-A ECLS 中发生率更高（30.0% 对比 21.9%，p<0.001）。 V-V ECLS（49.6% vs 66.6%，p<0.001）和 V-A ECLS（33.9% vs 44.9%，p<0.001）中出现出血并发症的患者的医院生存率较低。在过去 20 年中，观察到 V-V 和 V-A ECLS 的出血并发症稳步减少（系数：-1.124；P<0.001 和 -1.661；P<0.001）。随着时间的推移，V-V 或 V-A ECLS 中死亡率没有变化（系数：-0.147；P=0.442；系数：-0.195；P=0.139）。多变量回归显示高龄、ECLS 持续时间、手术插管、肾脏替代治疗、在 V-V ECLS 和 V-A ECLS 中作为独立出血预测因素的倾向定位：女性、ECLS 持续时间、ECLS 前停滞或移植过渡、治疗性低温和手术插管。在接受 ECLS 支持的这一大群患者中，发现过去 20 年出血量稳步减少，主要归因于手术和插管部位相关出血。然而，没有足够的数据将出血减少趋势仅归因于技术改进。尤其是插管部位出血的减少还归因于时机、患者选择和超声引导经皮插管的变化。其他类型的出血，例如中枢神经系统出血，保持稳定，总体出血仍然与死亡率持续增加有关。
Data about in-hospital outcomes in bleeding complications during extracorporeal life support (ECLS) have been poorly investigated. Retrospective observational study. Patients reported in Extracorporeal Life Support Organization (ELSO) Registry. Data of 53.644 adult patients (≥18 years old) mean age 51.4± 15.9 years, 33.859 (64.5%) male supported with single ECLS run between 01.01.2000 and 31.03.2020, 19.748 cannulated for V-V ECLS and 30.696 for V-A ECLS. Trends in bleeding complications, bleeding risk factors, and mortality. Bleeding complications were reported in 14.786 patients (27.6%); more often in V-A ECLS compared to V-V (30.0% versus 21.9%, p<0.001). Hospital survival in those who developed bleeding complications was lower in both V-V ECLS (49.6% versus 66.6%, p<0.001) and V-A ECLS (33.9 versus 44.9%, p<0.001). Steady decrease in bleeding complications in V-V and V-A ECLS was observed over the past 20 years (coef.: −1.124; P<0.001 and −1.661; P<0.001). No change in mortality rates was reported over time in V-V or V-A ECLS (coef.: −0.147; P=0.442 and coef.: −0.195; P=0.139). Multivariate regression revealed advanced age, ECLS duration, surgical cannulation, renal replacement therapy, prone positioning as independent bleeding predictors in V-V ECLS, in V-A ECLS: female gender, ECLS duration, pre-ECLS arrest or bridge to transplant, therapeutic hypothermia, and surgical cannulation. A steady decrease in bleeding over the last 20 years, mostly attributable to surgical and cannula-site related bleeding has been found in this large cohort of patients receiving ECLS support. However, there is not enough data to attribute the decreasing trends in bleeding to technological refinements alone. Especially reduction in cannulation site bleeding is also due to changes in timing, patient selection, and ultrasound guided percutaneous cannulation. Other types of bleeding, such as central nervous system, have remained stable and overall bleeding remains associated with a persistent increase in mortality.