Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation
Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation
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DOI：
10.1186/s13613-016-0196-7
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发表时间：
2016-10-06
影响因子：
8.1
通讯作者：
McQuilten, Zoe
中科院分区：
文献类型：
--
作者：
Aubron, Cecile;DePuydt, Joris;McQuilten, Zoe
背景：出血是危重患者体外膜肺氧合（ECMO）支持最常见的并发症。尽管如此，出血的风险因素描述不多，尤其是与ECMO支持期间凝血异常和抗凝治疗相关的因素。本研究的目的是描述在危重患者进行ECMO出血并发症，并确定出血events.Methods的危险因素：我们回顾性分析了ICU图表的成人谁收到无论是静脉-静脉（VV）或静脉-动脉（VA）ECMO支持在两个参与ICU之间2010年和2013年。根据体外生命支持组织（ELSO）的定义，比较了有和无出血并发症患者的特征，并使用生存分析评估了出血并发症对患者结局的影响。与出血独立相关的变量，包括ECMO过程中的日常临床和生物学变量，modeled.Results：在149 ECMO事件（111 VA ECMO和38 VV ECMO）在147名成年人中进行，89次（60%）并发至少一次出血事件。最常见的出血来源是：ECMO插管（37%）、血胸或心包填塞（17%）和耳鼻咽喉（16%）。5例（2.2%）患者发生颅内出血。出血并发症与较差的生存率独立相关[校正风险比（HR）2.17，95%置信区间（CI）1.07-4.41，P = 0.03]。术后活化部分凝血活酶时间（aPTT）[校正比值比（OR）3.00，95% CI 1.64-5.47，P < 0.01]、APACHE III评分[校正OR 1.01，95% CI 1.01-1.02，P = 0.01]和ECMO [校正OR 3.04，95% CI 1.62-5.69，P < 0.01]与出血发生的风险独立相关。出血和更高的aPTT之间的类似关联被发现时，非手术后VA ECMO被认为是independent.Conclusions：出血事件的基础上ELSO出血定义发生在超过60%的ECMO事件，并与医院死亡率。我们将既往出血的aPTT较高确定为出血事件的独立风险因素，这表明更好地控制aPTT（通过更好地控制凝血病或抗凝）可能改善患者的结局。
Background: Bleeding is the most frequent complication associated with extracorporeal membrane oxygenation (ECMO) support in critically ill patients. Nonetheless, risk factors for bleeding have been poorly described especially those associated with coagulation anomalies and anticoagulant therapy during ECMO support. The aim of this study is to describe bleeding complications in critically ill patients undergoing ECMO and to identify risk factors for bleeding events.Methods: We retrospectively analysed ICU charts of adults who received either veno-venous (VV) or veno-arterial (VA) ECMO support in two participating ICUs between 2010 and 2013. Characteristics of patients with and without bleeding complications, as per the Extracorporeal Life Support Organisation (ELSO) definition, were compared, and the impact of bleeding complications on patient outcomes was assessed using survival analysis. Variables that were independently associated with bleeding, including daily clinical and biological variables during ECMO courses, were modelled.Results: Of the 149 ECMO episodes (111 VA ECMO and 38 VV ECMO) performed in 147 adults, 89 episodes (60 %) were complicated by at least one bleeding event. The most common bleeding sources were: ECMO cannula (37 %), haemothorax or cardiac tamponade (17 %) and ear-nose and throat (16 %). Intra-cranial haemorrhage occurred in five (2.2 %) patients. Bleeding complications were independently associated with worse survival [adjusted hazard ratio (HR) 2.17, 95 % confidence interval (CI) 1.07-4.41, P = 0.03]. Higher activated partial thromboplastin time (aPTT) [adjusted odds ratio (OR) 3.00, 95 % CI 1.64-5.47, P < 0.01], APACHE III score [adjusted OR 1.01, 95 % CI 1.01-1.02, P = 0.01] and ECMO following surgery [adjusted OR 3.04, 95 % CI 1.62-5.69, P < 0.01] were independently associated with greater risk of bleeding occurrence. A similar association between bleeding and higher aPTT was found when non-post-surgical VA ECMO was considered separately.Conclusions: Bleeding events based on the ELSO bleeding definition occurred in more than 60 % of ECMO episodes and were associated with hospital mortality. We identified higher aPTT prior bleeding as an independent risk factor for bleeding event, suggesting that better control of the aPTT (through a better control of either coagulopathy or anticoagulation) may improve patients' outcome.