Concurrent initiation of intra-aortic balloon pumping with extracorporeal membrane oxygenation reduced in-hospital mortality in postcardiotomy cardiogenic shock
Concurrent initiation of intra-aortic balloon pumping with extracorporeal membrane oxygenation reduced in-hospital mortality in postcardiotomy cardiogenic shock
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DOI：
10.1186/s13613-019-0496-9
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发表时间：
2019-01-23
影响因子：
8.1
通讯作者：
Hu, Shengshou
中科院分区：
文献类型：
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作者：
Chen, Kai;Hou, Jianfeng;Hu, Shengshou
背景静脉-动脉体外膜氧合（VA-ECMO）广泛应用于心脏切开术后心脏休克（PCS）。影响接受 ECMO 治疗 PCS 的患者死亡率的因素仍不清楚。在本研究中，我们分析了ECMO用于PCS的结果、预测因素和并发症。方法连续纳入152名在阜外医院接受VA-ECMO治疗PCS的成人受试者。我们回顾性收集了基线特征、结果和并发症。比较幸存者与非幸存者的基线特征，并进行逻辑回归以确定院内死亡率的预测因素。结果受试者的平均年龄为49.514.1岁，其中男性占73.7%。主要手术方式为心脏移植（32.2%）、冠状动脉搭桥术（17%）和瓣膜手术（11.8%）。 32.2% 的受试者与 ECMO 同时启动主动脉内球囊反搏 (IABP)，18.4% 的受试者随后启动主动脉内球囊反搏 (IABP)。 ECMO撤机率为56.6%，院内死亡率为52.0%。与非幸存者相比，幸存者的高血压发生率较低（15.1% vs. 35.4%，p=0.004），ECMO 启动前二次开胸手术（19.2% vs. 39.2%，p=0.007）、ECMO 前心脏骤停/心室颤动（11.0% vs. 34.2%，p=0.001）、ECMO 床边植入率较低（11.0% 对比 41.8%，p
BackgroundVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used in postcardiotomy cardiac shock (PCS). The factors that affect mortality in patients who receive ECMO for PCS remain unclear. In this study, we analyzed the outcomes, predictive factors and complications of ECMO use for PCS.MethodsA total of 152 adult subjects who received VA-ECMO for PCS in Fuwai Hospital were consecutively included. We retrospectively collected the baseline characteristics, outcomes and complications. Baseline characteristics were compared between survivors with non-survivors, and logistic regression was performed to identify predictive factors for in-hospital mortality.ResultsThe mean age of the subjects was 49.514.1years, with a male dominancy of 73.7%. The main surgical procedures were heart transplantation (32.2%), coronary artery bypass graft (17%) and valvular surgery (11.8%). Intra-aortic balloon pumping (IABP) was initiated concurrently with ECMO in 32.2% subjects and sequentially in 18.4% subjects. The ECMO weaning rate was 56.6%, and the in-hospital mortality was 52.0%. When compared with non-survivors, survivors had less hypertension (15.1% vs. 35.4%, p=0.004), secondary thoracotomy before ECMO initiation (19.2% vs. 39.2%, p=0.007), pre-ECMO cardiac arrest/ventricular fibrillation (11.0% vs. 34.2%, p=0.001), bedside implantation of ECMO (11.0% vs. 41.8%, p