National trends and outcomes for extra-corporeal membrane oxygenation use in high-risk pulmonary embolism
National trends and outcomes for extra-corporeal membrane oxygenation use in high-risk pulmonary embolism
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DOI：
10.1177/1358863x18824650
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发表时间：
2019-06-01
影响因子：
3.5
通讯作者：
Cameron, Scott J.
中科院分区：
文献类型：
--
作者：
Elbadawi, Ayman;Mentias, Amgad;Cameron, Scott J.
在美国，对于高危肺栓塞（PE）患者体外膜氧合（ECMO）的时间趋势和结果知之甚少。我们查询了2005年至2013年的国家住院患者样本（NIS）数据库，以确定入院的高危PE患者。我们的目的是确定高危PE患者使用ECMO的趋势。我们还评估了接受ECMO的高风险PE患者的住院结果。我们评估了77,809例高风险PE住院病例。ECMO使用率由2005年的0.07%上升至2013年的1.1% （p = 0.015）。ECMO在城市教学医院和大型医院应用较多。使用ECMO与大量PE患者较低的死亡率相关（p < 0.001）。接受ECMO患者的住院死亡率为61.6%，在观察期内无变化（p = 0.68）。我们的研究揭示了使用ECMO作为血流动力学支持的高危PE患者死亡率增加的几个独立预测因素，包括：年龄、女性、肥胖、充血性心力衰竭和慢性肺部疾病。因此，当选择具有良好临床特征的患者时，ECMO作为一种抢救策略或最终治疗的桥梁，可能对高危PE的管理有效。
Little is known about the temporal trends and outcomes for extra-corporeal membrane oxygenation (ECMO) in patients with high-risk pulmonary embolism (PE) in the United States. We queried the National Inpatient Sample (NIS) database from 2005 to 2013 to identify patients admitted with high-risk PE. Our objective was to determine trends for ECMO use in patients with high-risk PE. We also assessed in-hospital outcomes among patients with high-risk PE receiving ECMO. We evaluated 77,809 hospitalizations for high-risk PE. There was an upward trend in the utilization of ECMO from 0.07% in 2005 to 1.1% in 2013 (p = 0.015). ECMO was utilized more in urban teaching hospitals and large hospitals. ECMO use was associated with lower mortality in patients with massive PE (p < 0.001). In-hospital mortality for patients receiving ECMO was 61.6%, with no change over the observational period (p = 0.68). Our investigation revealed several independent predictors of increased mortality in patients with high-risk PE using ECMO as hemodynamic support, including: age, female sex, obesity, congestive heart failure, and chronic pulmonary disease. ECMO, therefore, as a rescue strategy or bridge to definitive treatment, may be effective in the management of high-risk PE when selecting patients with favorable clinical characteristics.