Major Bleeding in Adults Undergoing Peripheral Extracorporeal Membrane Oxygenation (ECMO): Prognosis and Predictors.
Major Bleeding in Adults Undergoing Peripheral Extracorporeal Membrane Oxygenation (ECMO): Prognosis and Predictors.
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DOI：
10.1155/2022/5348835
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发表时间：
2022
影响因子：
1.7
通讯作者：
Ngoc Pham TT
中科院分区：
文献类型：
--
作者：
Nguyen TP;Phan XT;Nguyen TH;Huynh DQ;Tran LT;Pham HM;Nguyen TN;Kieu HT;Ngoc Pham TT
大出血是ECMO患者常见的严重并发症，结局较差。采用新型微创插管方法和更密切的凝血监测制度，目前尚未确定大出血的发生率。我们的研究旨在探讨外周ECMO患者大出血的发生率、决定因素及其与死亡率的关系。 我们对2019年1月至2020年1月在三级转诊医院接受外周ECMO的成人患者进行了一项单中心回顾性研究。通过logistic回归分析确定大出血的决定因素。采用考克斯比例风险回归分析确定住院死亡的危险因素。 33/105例患者（31.4%）报告了大出血，并与较高的住院死亡率相关[校正风险比（aHR）3.56，95%置信区间（CI）1.63-7.80，p < 0.001）。两组患者的年龄、性别、ECMO适应证、ECMO模式、ECMO前APACHE-II和SOFA评分无显著差异。仅APTT >72秒[校正比值比（aOR）7.10，95%CI 2.60-19.50，p < 0.001]，纤维蛋白原<2 g/L [aOR = 7.10，95%CI 2.60-19.50，p < 0.001]，ACT >220秒[aOR = 3.9，95%CI 1.20-11.80，p <0.001]，p=0.017]为独立预测因素。 总之，在外周ECMO患者中，大出血仍然有相当高的发生率和不良结局。APTT > 72秒、纤维蛋白原< 2 g/L是大出血事件的最强预测因素。
Major bleeding has been a common and serious complication with poor outcomes in ECMO patients. With a novel, less-invasive cannulation approach and closer coagulation monitoring regime, the incidence of major bleeding is currently not determined yet. Our study aims to examine the incidence of major bleeding, its determinants, and association with mortality in peripheral-ECMO patients. We conducted a single-center retrospective study on adult patients undergoing peripheral-ECMO between January 2019 and January 2020 at a tertiary referral hospital. Determinants of major bleeding were defined by logistic regression analysis. Risk factors of in-hospital mortality were determined by Cox proportional hazard regression analysis. Major bleeding was reported in 33/105 patients (31.4%) and was associated with higher in-hospital mortality [adjusted hazard ratio (aHR) 3.56, 95% confidence interval (CI) 1.63–7.80, p < 0.001). There were no significant difference in age, sex, ECMO indications, ECMO modality, pre-ECMO APACHE-II and SOFA scores between two groups with and without major bleeding. Only APTT >72 seconds [adjusted odds ratio (aOR) 7.10, 95% CI 2.60–19.50, p < 0.001], fibrinogen <2 g/L [aOR = 7.10, 95% CI 2.60–19.50, p < 0.001], and ACT >220 seconds [aOR = 3.9, 95% CI 1.20–11.80, p=0.017] on days with major bleeding were independent predictors. In summary, major bleeding still had a fairly high incidence and poor outcome in peripheral-ECMO patients. APTT > 72 seconds, fibrinogen < 2 g/L were the strongest predicting factors for major bleeding events.
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影响因子：
4.2
作者：
McMichael, Ali B. V.;Hornik, Christoph P.;Hupp, Susan R.;Gordon, Sharon E.;Ozment, Caroline P.
通讯作者：
Ozment, Caroline P.
影响因子：
1.2
作者：
Atallah, S.;Liebl, M.;Masud, F.
通讯作者：
Masud, F.
影响因子：
3.1
作者：
Martucci, Gennaro;Panarello, Giovanna;Arcadipane, Antonio
通讯作者：
Arcadipane, Antonio
影响因子：
4.6
作者：
Mazzeffi, Michael;Greenwood, John;Pham, Si
通讯作者：
Pham, Si
影响因子：
8.1
作者：
Aubron, Cecile;DePuydt, Joris;McQuilten, Zoe
通讯作者：
McQuilten, Zoe