Risk Factors of Ischemic and Hemorrhagic Strokes During Venovenous Extracorporeal Membrane Oxygenation: Analysis of Data From the Extracorporeal Life Support Organization Registry.
Risk Factors of Ischemic and Hemorrhagic Strokes During Venovenous Extracorporeal Membrane Oxygenation: Analysis of Data From the Extracorporeal Life Support Organization Registry.
复制标题
DOI：
10.1097/ccm.0000000000004707
复制
发表时间：
2021-01-01
影响因子：
8.8
通讯作者：
中科院分区：
文献类型：
--
作者：
接受静脉-静脉体外膜肺氧合（V-V ECMO）的患者常报告卒中，但风险因素尚未得到充分描述。我们试图确定在V-V ECMO支持下患者的ECMO前和ECMO上缺血性和出血性卒中的危险因素。回顾性分析。2013年至2019年，366家ECMO中心向体外循环生命支持组织报告的数据。年龄大于18岁的患者支持单次V-V ECMO运行。没有。在15,872例V-V ECMO患者中，812例（5.1%）至少有一种类型的急性脑损伤（ABI），定义为缺血性卒中、出血性卒中或脑死亡。总体而言，215例（1.4%）发生缺血性卒中，484例（3.1%）发生出血性卒中。总的住院死亡率为36%，但缺血性或出血性卒中患者的死亡率更高（分别为68%和73%）。在多变量分析中，ECMO前pH（校正OR [aOR]=0.10; 95% CI，0.03-0.35; p<0.001），溶血（aOR=2.27; 95% CI=1.22-4.24; p=0.010），胃肠道出血（aOR=2.01; 95%CI =1.12-3.59; p=0.019）和弥散性血管内凝血（aOR=3.61; 95%CI =1.51-8.66; p=0.004）与缺血性卒中独立相关。ECMO前pH值（aOR=0.28; 95% CI，0.12-0.65; p=0.003），ECMO前PO2（aOR=0.96; 95% CI=0.93-0.99; p=0.021），胃肠道出血（aOR=1.70; 95%CI =1.15-2.51; p=0.008）和肾脏替代治疗（aOR=1.57; 95%CI =1.22-2.02; p<0.001）与出血性卒中独立相关。在ELSO登记研究的V-V ECMO患者中，约5%患有ABI。当发生缺血性或出血性卒中时，死亡率增加2倍。围插管期的低pH值和低氧血症以及凝血障碍标志物等风险因素与ABI相关。有必要进一步研究了解ECMO前和ECMO上的风险因素以及ABI的时间，以制定适当的预防和管理策略。
Stroke is commonly reported in patients receiving veno-venous extracorporeal membrane oxygenation (V-V ECMO), but risk factors are not well described. We sought to determine pre-ECMO and on-ECMO risk factors for both ischemic and hemorrhagic stroke in patients with V-V ECMO support. Retrospective analysis. Data reported to the Extracorporeal Life Support Organization by 366 ECMO centers from 2013 to 2019. Patients older than 18 years old supported with a single run of V-V ECMO. None. Of 15,872 V-V ECMO patients, 812 (5.1%) had at least one type of acute brain injury (ABI), defined as ischemic stroke, hemorrhagic stroke, or brain death. Overall, 215 (1.4%) experienced ischemic stroke and 484 (3.1%) experienced hemorrhagic stroke. Overall in-hospital mortality was 36%, but rates were higher in those with ischemic or hemorrhagic stroke (68% and 73%, respectively). In multivariable analysis, pre-ECMO pH (adjusted OR [aOR]=0.10; 95% CI, 0.03–0.35; p<0.001), hemolysis (aOR=2.27; 95% CI=1.22–4.24; p=0.010), gastrointestinal hemorrhage (aOR=2.01; 95% CI=1.12–3.59; p=0.019), and disseminated intravascular coagulation (aOR=3.61; 95% CI=1.51–8.66; p=0.004) were independently associated with ischemic stroke. Pre-ECMO pH (aOR=0.28; 95% CI, 0.12–0.65; p=0.003), pre-ECMO PO2 (aOR=0.96; 95% CI=0.93–0.99; p=0.021), gastrointestinal hemorrhage (aOR=1.70; 95% CI=1.15–2.51; p=0.008), and renal replacement therapy (aOR=1.57; 95% CI=1.22–2.02; p<0.001) were independently associated with hemorrhagic stroke. Among V-V ECMO patients in the ELSO registry, approximately 5% had ABI. Mortality rates increased 2-fold when ischemic or hemorrhagic strokes occurred. Risk factors such as lower pH and hypoxemia during the peri-cannulation period and markers of coagulation disturbances were associated with ABI. Further research on understanding pre-ECMO and on-ECMO risk factors and the timing of ABI is necessary to develop appropriate prevention and management strategies.