Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review.
Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review.
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DOI：
10.3389/fneur.2018.00548
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发表时间：
2018
影响因子：
3.4
通讯作者：
Bellander BM
中科院分区：
文献类型：
--
作者：
Fletcher-Sandersjöö A;Thelin EP;Bartek J Jr;Broman M;Sallisalmi M;Elmi-Terander A;Bellander BM
背景：颅内出血(ICH)是成人体外膜肺氧合(ECMO)治疗的常见并发症。目的：本研究的目的是对成人患者ECMO相关性脑出血的发生率、结局和预测因素的文献进行系统回顾，并对其病理生理学、处理和未来前景进行叙述性回顾。方法：系统检索Medline、EMBASE、Cochrane系统综述数据库和www.Clinicaltrials.gov。报告的成人ECMO相关性脑出血的发生率、结果或预测因素(≥为18岁)的研究符合纳入条件。结果：纳入系统综述的文献25篇。ECMO相关性脑出血的发生率从1.8%到21%不等。脑出血组的死亡率在32%至100%之间，与非脑出血组相比，死亡率的相对危险度为1.27-4.43。脑出血的风险增加与ECMO持续时间、抗血栓治疗、内凝血改变、肾功能衰竭、需要血液制品、ECMO开始时迅速高碳酸血症，甚至ECMO前的发病率有关。结论：ICH是接受ECMO治疗的成人患者的常见并发症，且与死亡率增加有关。在ECMO期间治疗ICH代表了促凝血和抗凝需求之间的平衡。神经外科治疗与严重的发病率有关，但在选定的病例中取得了成功。未来的研究应旨在探讨无创性监测在早期发现ECMO相关性脑出血中的有效性和可行性。
Background: Intracranial hemorrhage (ICH) is a common complication in adults treated with extracorporeal membrane oxygenation (ECMO). Objectives: The aim of this study was to conduct a systematic review of the literature on the incidence, outcome and predictors of ECMO-associated ICH in adult patients, supplemented by a narrative review of its pathophysiology, management and future perspectives. Methods: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and www.clinicaltrials.gov were systematically searched. Studies that reported incidence, outcome or predictors of ECMO-associated ICH in adults (≥18 years) were eligible for inclusion. Results: Twenty five articles were included in the systematic review. The incidence of ECMO-associated ICH varied between 1.8 and 21 %. Mortality rates in ICH-cohorts varied between 32 and 100 %, with a relative risk of mortality of 1.27–4.43 compared to non-ICH cohorts. An increased risk of ICH was associated with ECMO-duration, antithrombotic therapy, altered intrinsic coagulation, renal failure, need of blood products, rapid hypercapnia at ECMO initiation, and even pre-ECMO morbidity. Conclusions: ICH is a common complication in adults treated with ECMO and associated with increased mortality. Treating an ICH during ECMO represents a balance between pro- and anticoagulatory demands. Neurosurgical treatment is associated with severe morbidity, but has been successful in selected cases. Future studies should aim at investigating the validity and feasibility of non-invasive monitoring in early detection of ECMO-associated ICH.
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影响因子：
8.3
作者：
Hemphill, JC;Bonovich, DC;Johnston, SC
通讯作者：
Johnston, SC
影响因子：
3.4
作者：
Floerchinger, Bernhard;Philipp, Alois;Schmid, Christof
通讯作者：
Schmid, Christof
影响因子：
15.1
作者：
Aubron, Cecile;Cheng, Allen C.;Pellegrino, Vince
通讯作者：
Pellegrino, Vince
影响因子：
1.8
作者：
Gerke, Alicia K;Tang, Fan;Polgreen, Philip M
通讯作者：
Polgreen, Philip M
影响因子：
8.1
作者：
Aubron, Cecile;DePuydt, Joris;McQuilten, Zoe
通讯作者：
McQuilten, Zoe