Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure: Findings From the Extracorporeal Life Support Organization Database
Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure: Findings From the Extracorporeal Life Support Organization Database
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DOI：
10.1097/ccm.0000000000002502
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发表时间：
2017-08-01
影响因子：
8.8
通讯作者：
Thiagarajan, Ravi R.
中科院分区：
文献类型：
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作者：
Lorusso, Roberto;Gelsomino, Sandro;Thiagarajan, Ravi R.
目的：评估接受静脉-静脉体外膜氧合治疗呼吸衰竭的成人患者的院内神经系统并发症。设计：对体外生命支持组织的数据注册表进行回顾性分析。环境：1992-2015年350个国际体外膜氧合中心向体外生命支持组织报告的数据。患者：成人（>= 18岁）支持静脉-静脉体外膜氧合治疗呼吸衰竭。干预措施:没有。测量和主要结果：我们纳入了4,988名接受静脉-静脉体外膜氧合治疗呼吸衰竭的成年人。神经损伤定义为在体外膜氧合支持期间发生的脑死亡、癫痫发作、中风和颅内出血。我们使用多变量逻辑回归来探讨与神经损伤相关的患者和体外膜氧合因子。研究队列的中位年龄为46岁（四分位数范围为32-58岁）。356例患者（7.1%）报告了426例神经系统并发症，包括181例颅内出血（42.5%），100例脑死亡（23.5%），85例中风（19.9%）和60例癫痫发作（14.1%）。伴有中枢神经系统并发症的住院死亡率明显更高（75.8% vs 37.8%, p < 0.001），且因中枢神经系统损伤类型而异；颅内出血患者死亡率为79.6%，脑卒中患者死亡率为68.2%，癫痫发作患者死亡率为50%。体外膜氧合过程中的心脏骤停、持续的静脉-静脉血液滤过和高胆红素血症与神经损伤的几率增加有关。结论：在接受静脉-静脉体外膜氧合治疗呼吸衰竭的成年人中，大约7%的人有神经损伤。颅内出血是最常见的类型，神经损伤患者的生存率较差。未来的研究应评估抗凝管理以及脑/体外膜氧合相互作用，以减少这些危及生命的事件。
Objectives: To assess in-hospital neurologic (CNS) complications in adult patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure.Design: Retrospective analysis of the Extracorporeal Life Support Organization's data registry.Setting: Data reported to Extracorporeal Life Support Organization from 350 international extracorporeal membrane oxygenation centers during 1992-2015.Patients: Adults (>= 18 yr old) supported with veno-venous extracorporeal membrane oxygenation for respiratory failure.Interventions: None.Measurements and Main Results: We included 4,988 adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. Neurologic injury was defined as brain death, seizures, stroke, and intracranial hemorrhage occurring during extracorporeal membrane oxygenation support. We used multivariable logistic regression to explore patient and extracorporeal membrane oxygenation factors associated with neurologic injury. Median age of the study cohort was 46 (interquartile range, 32-58). Four hundred twenty-six neurologic complications were reported in 356 patients (7.1%), and included 181 intracranial hemorrhage (42.5%), 100 brain deaths (23.5%), 85 stroke (19.9%), and 60 seizure events (14.1%). In-hospital mortality was significantly higher for those with CNS complications (75.8% vs 37.8%; p < 0.001) and varied by type of CNS injury; mortality was 79.6% in patients with intracranial hemorrhage, 68.2% in patients with stroke, and 50% in patients with seizures. Pre-extracorporeal membrane oxygenation cardiac arrest, continuous veno-venous hemofiltration, and hyperbilirubinemia during extracorporeal membrane oxygenation were associated with increased odds of neurologic injury.Conclusions: Approximately 7% of adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure had neurologic injury. Intracranial hemorrhage was the most frequent type, and survival for patients with neurologic injury was poor. Future investigations should evaluate anticoagulation management as well as brain/extracorporeal membrane oxygenation interaction to reduce these life-threatening events.