Pulmonary Artery Pressures and Mortality during VA ECMO: An ELSO Registry Analysis.
Pulmonary Artery Pressures and Mortality during VA ECMO: An ELSO Registry Analysis.
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VA ECMO 期间的肺动脉压力和死亡率：ELSO 登记分析。
DOI：
10.1101/2023.08.08.23293859
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Tonna,JosephE
中科院分区：
文献类型：
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作者：
Owyang,ClarkG;Rippon,Brady;Teran,Felipe;Brodie,Daniel;Araos,Joaquin;Burkhoff,Daniel;Kim,Jiwon;Tonna,JosephE
背景：系统血流动力学和特定的呼吸机设置已被证明可以预测静脉动脉体外膜氧合（VA ECMO）期间的生存。虽然这些因素与右心室（RV）功能交织在一起，但右心室功能与VA ECMO期间存活之间的独立关系尚不清楚。目的探讨左心室功能与死亡率及ECMO支持时间的关系。方法查询2010年至2022年体外生命支持组织（ELSO）登记的成人心脏ECMO运行情况。通过肺动脉脉压（PAPP）量化ecmo前和非ecmo期间的RV功能。根据心血管血管造影与干预学会（SCAI）的分期、年龄、性别和同期临床数据（即肺血管扩张剂和全身脉压）调整多变量模型。主要终点是住院死亡率。结果4442例ECMO符合纳入标准，并有血流动力学和疾病严重程度变量的记录。死亡率为55%；与幸存者相比，非幸存者年龄更大，SCAI分期更差，ecmo前气管插管时间更长（P < 0.05）。从ecmo前到ecmo后PAPP的改善（Δ PAPP）与每10 mm Hg升高的死亡率降低相关（OR: 0.91 [95% CI: 0.86-0.96]； P=0.002）。ECMO上PAPP的增加与每10mmhg ECMO上时间的延长相关（Beta值：15 [95% CI: 7.7-21]； P<0.001）。结论早期ECMO前心室功能的改善与心脏ECMO期间死亡率的降低有关。应考虑将Δ PAPP纳入风险预测模型。
BackgroundSystemic hemodynamics and specific ventilator settings have been shown to predict survival during venoarterial extracorporeal membrane oxygenation (VA ECMO). While these factors are intertwined with right ventricular (RV) function, the independent relationship between RV function and survival during VA ECMO is unknown.ObjectivesTo identify the relationship between RV function with mortality and duration of ECMO support.MethodsCardiac ECMO runs in adults from the Extracorporeal Life Support Organization (ELSO) Registry between 2010 and 2022 were queried. RV function was quantified via pulmonary artery pulse pressure (PAPP) for pre-ECMO and on-ECMO periods. A multivariable model was adjusted for Society for Cardiovascular Angiography and Interventions (SCAI) stage, age, gender, and concurrent clinical data (i.e., pulmonary vasodilators and systemic pulse pressure). The primary outcome was in-hospital mortality.ResultsA total of 4,442 ECMO runs met inclusion criteria and had documentation of hemodynamic and illness severity variables. The mortality rate was 55%; non-survivors were more likely to be older, have a worse SCAI stage, and have longer pre-ECMO endotracheal intubation times (P < 0.05 for all) than survivors. Improving PAPP from pre-ECMO to on-ECMO time (Δ PAPP) was associated with reduced mortality per 10 mm Hg increase (OR: 0.91 [95% CI: 0.86–0.96]; P=0.002). Increasing on-ECMO PAPP was associated with longer time on ECMO per 10 mm Hg (Beta: 15 [95% CI: 7.7–21]; P<0.001).ConclusionsEarly improvements in RV function from pre-ECMO values were associated with mortality reduction during cardiac ECMO. Incorporation of Δ PAPP into risk prediction models should be considered.