Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock
Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock
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DOI：
10.1016/j.jtcvs.2009.10.043
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发表时间：
2010-02-01
影响因子：
6
通讯作者：
Mohr, Friedrich Wilhelm
中科院分区：
文献类型：
--
作者：
Rastan, Ardawan Julian;Dege, Andreas;Mohr, Friedrich Wilhelm
目的：成人心切开术后可能需要机械循环支持的心源性休克发生率为0.5%至1.5%。影响体外膜氧合植入后的早期或长期结果的风险因素没有得到很好的描述。方法：1996年5月至2008年5月，517例成人患者接受体外膜氧合支持心切开术后心源性休克。手术包括单纯冠状动脉旁路移植术（37.4%）、单纯瓣膜手术（14.3%）、冠状动脉旁路移植术加瓣膜手术（16.8%）、胸部器官移植（6.5%）和其他组合（25.0%）。结果：平均年龄为63.5岁，71.5%为男性，射血分数为45.9% ± 17.6%，Logistic EuroSCORE为21.6% ± 20.7%。经胸（60.8%）或胸外（39.2%）插管建立肺外膜氧合。体外膜氧合支持为3.28 +/- 2.85天。74.1%的患者植入了主动脉内球囊反搏。体外膜肺氧合脱机成功率为63.3%，出院率为24.8%。脑血管事件发生率为17.4%，胃肠道并发症发生率为18.8%，肾脏替代治疗发生率为65.0%。住院死亡的危险因素为年龄大于70岁（比值比，1.6）、糖尿病（比值比，2.5）、术前肾功能不全（比值比，2.1）、肥胖（比值比，1.8）、Logistic EuroSCORE大于20%（比值比，1.8）、手术乳酸大于4 mmol/L（比值比，2.2）。孤立性冠状动脉旁路移植术（优势比，0.44）是保护。累积生存率为17.6%，6个月后，16.5%，1年后，13.7%，5 years.Conclusions：体外膜肺氧合支持是一个可以接受的选择，心切开术后心源性休克的患者，否则会死亡，是合理的医院幸存者的长期良好的结果。由于高发病率和死亡率，体外膜肺氧合必须根据个人风险状况决定。（《胸血管外科杂志》2010; 139：302-311）
Objective: Adult postcardiotomy cardiogenic shock potentially requiring mechanical circulatory support occurs in 0.5% to 1.5% of cases. Risk factors influencing early or long-term outcome after extracorporeal membrane oxygenation implantation are not well described.Methods: Between May 1996 and May 2008, 517 adult patients received extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock. Procedures were isolated coronary artery bypass grafting (37.4%), isolated valve surgery (14.3%), coronary artery bypass grafting plus valve surgery (16.8%), thoracic organ transplantion (6.5%), and other combinations (25.0%). Fifty-four preoperative and 42 procedural risk factors concerning in-hospital mortality were evaluated by logistic regression analyses.Results: Mean age was 63.5 years, 71.5% were male, ejection fraction was 45.9% +/- 17.6%, logistic EuroSCORE was 21.6% +/- 20.7%. Extracorporeal membrane oxygenation was established through thoracic (60.8%) or extrathoracic (39.2%) cannulation. Extracorporeal membrane oxygenation support was 3.28 +/- 2.85 days. Intra-aortic balloon pumps were implanted in 74.1%. Weaning from extracorporeal membrane oxygenation was successful for 63.3%, and 24.8% were discharged. Cerebrovascular events occurred in 17.4%, gastrointestinal complications in 18.8%, and renal replacement therapy in 65.0%. Risk factors for hospital mortality were age older than 70 years (odds ratio, 1.6), diabetes (odds ratio, 2.5), preoperative renal insufficiency (odds ratio, 2.1), obesity (odds ratio, 1.8), logistic EuroSCORE greater than 20% (odds ratio, 1.8), operative lactate greater than 4 mmol/L (odds ratio, 2.2). Isolated coronary artery bypass grafting (odds ratio, 0.44) was protective. Cumulative survivals were 17.6% after 6 months, 16.5% after 1 year, and 13.7% after 5 years.Conclusions: Extracorporeal membrane oxygenation support is an acceptable option for patients with postcardiotomy cardiogenic shock who otherwise would die and is justified by good long-term outcome of hospital survivors. Because of high morbidity and mortality, extracorporeal membrane oxygenation must be decided by individual risk profile. (J Thorac Cardiovasc Surg 2010; 139: 302-311)