Modifiable Risk Factors and Mortality From Ischemic and Hemorrhagic Strokes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Organization Registry.
Modifiable Risk Factors and Mortality From Ischemic and Hemorrhagic Strokes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Organization Registry.
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DOI：
10.1097/ccm.0000000000004498
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发表时间：
2020-10
影响因子：
8.8
通讯作者：
Whitman G
中科院分区：
文献类型：
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作者：
Cho SM;Canner J;Chiarini G;Calligy K;Caturegli G;Rycus P;Barbaro RP;Tonna J;Lorusso R;Kilic A;Choi CW;Ziai W;Geocadin R;Whitman G
尽管急性脑损伤（ABI）在接受体外膜氧合（ECMO）治疗的患者中很常见，但对缺血性和出血性卒中的机制和预测因素知之甚少。我们的目的是确定静脉动脉(VA)-ECMO支持患者的每种缺血性和出血性卒中的危险因素和结局。回顾性分析。2013年至2017年，310个体外膜氧合中心向体外生命支持组织报告数据。18岁以上患者支持单次VA-ECMO。没有。在10342例V-A ECMO患者中，401例（3.9%）发生缺血性卒中，229例（2.2%）发生出血性卒中。V-A ECMO期间报告的ABI在5年内从10%下降到6%。总体住院死亡率为56%，但当出现缺血性卒中和出血性卒中时，死亡率更高（分别为76%和86%）。在多变量分析中，较低的ECMO前pH值（校正优势比[aOR]， 0.21; 95%CI, 0.09-0.49; p<0.001）、ECMO第一天较高的PO2 （aOR, 1.01; 95%CI, 1.00-1.02; p=0.009）、较高的ECMO回路机械故障发生率（aOR, 1.33; 95%CI, 1.02-1.74; p=0.03）和肾脏替代治疗（aOR, 1.49; 95%CI, 1.14-1.94; p=0.004）与缺血性卒中独立相关。女性（aOR, 1.61, 95%CI, 1.16-2.22, p=0.004）、ECMO持续时间（aOR, 1.01, 95%CI, 1.00-1.03, p=0.02）、肾脏替代治疗（aOR, 1.81, 95%CI, 1.30-2.52, p<0.001）和溶血（aOR, 1.87, 95%CI, 1.11-3.16, p=0.02）与出血性卒中独立相关。尽管近年来ABI的发病率有所下降，但缺血性和出血性中风的死亡率仍然很高。未来的研究有必要了解相关风险因素的时机，以促进预防和管理策略。
Although acute brain injury (ABI) is common in patients receiving extracorporeal membrane oxygenation (ECMO), little is known regarding the mechanism and predictors of ischemic and hemorrhagic stroke. We aimed to determine the risk factors and outcomes of each ischemic and hemorrhagic stroke in patients with venoarterial (VA)-ECMO support. Retrospective analysis. Data reported to the Extracorporeal Life Support Organization by 310 extracorporeal membrane oxygenation centers from 2013 to 2017. Patients more than 18 years old supported with a single run of VA-ECMO. None. Of 10,342 V-A ECMO patients, 401 (3.9%) experienced ischemic stroke and 229 (2.2%) experienced hemorrhagic stroke. Reported ABI during V-A ECMO decreased from 10% to 6% in 5 years. Overall in-hospital mortality was 56%, but rates were higher when ischemic stroke and hemorrhagic stroke were present (76% and 86%, respectively). In multivariable analysis, lower pre-ECMO pH (adjusted odds ratio [aOR], 0.21; 95%CI, 0.09–0.49; p<0.001), higher PO2 on first day of ECMO (aOR, 1.01; 95%CI, 1.00–1.02; p=0.009), higher rates of ECMO circuit mechanical failure (aOR, 1.33; 95%CI, 1.02–1.74; p=0.03), and renal replacement therapy (aOR, 1.49; 95%CI, 1.14–1.94; p=0.004) were independently associated with ischemic stroke. Female sex (aOR, 1.61; 95%CI, 1.16–2.22; p=0.004), ECMO duration (aOR, 1.01; 95%CI, 1.00–1.03; p=0.02), renal replacement therapy (aOR, 1.81; 95%CI, 1.30–2.52; p<0.001), and hemolysis (aOR, 1.87; 95%CI, 1.11–3.16; p=0.02) were independently associated with hemorrhagic stroke. Despite a decrease in the incidence of ABI in recent years, mortality rates remain high when ischemic and hemorrhagic strokes are present. Future research is necessary on understanding the timing of associated risk factors to promote prevention and management strategy.