Early and Intermediate Results of Rescue Extracorporeal Membrane Oxygenation in Adult Cardiogenic Shock
Early and Intermediate Results of Rescue Extracorporeal Membrane Oxygenation in Adult Cardiogenic Shock
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DOI：
10.1016/j.athoracsur.2009.08.009
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发表时间：
2009-12-01
影响因子：
4.6
通讯作者：
Meng, Xu
中科院分区：
文献类型：
--
作者：
Wang, Jiangang;Han, Jie;Meng, Xu
背景我们回顾性评估了使用临时体外膜肺氧合（ECMO）支持的早期和中期结果，并检查了其对生活质量（QOL）的影响。4年内，12，644例接受心脏手术的患者中有62例（0.49%）（瓣膜手术，n = 39;冠状动脉旁路移植术，n = 13;冠状动脉旁路移植术加瓣膜手术，n = 4;心脏移植术，n = 4;全主动脉弓置换术，n = 2）需要临时术后ECMO支持。在一项随访研究中（平均2.3 ± 1.5年，100%完成），32人仍然活着，并回答了简短的36健康调查QOL量表。ECMO支持的平均持续时间为61 +/- 37小时。40例患者（64.5%）成功脱离ECMO。34例患者（54.8%）在44.3 +/- 17.6天后出院。住院死亡率为45.2%，主要死亡原因为多器官功能衰竭。院内死亡的一个危险因素是ECMO启动前乳酸峰值水平大于12 mol/L。ECMO幸存者与其他接受心脏手术但未接受ECMO支持的患者之间的平均QOL评分几乎没有显著差异; ECMO幸存者中仅活力和心理健康指标显著较低（p < 0.05）。ECMO存活者和未接受ECMO支持的患者的生活质量评分（除活力和心理健康外）均显著低于中国普通人群（p <0. 05）。体外膜肺氧合是治疗成人术后心源性休克的一种可接受的技术，尽管早期干预和减少并发症可以改善结果。然而，ECMO的使用对QOL的影响不大。
Background. We retrospectively evaluated the early and intermediate results of use of temporary extracorporeal membrane oxygenation (ECMO) support and examined its effect on quality of life (QOL).Methods. Over four years 62 of 12,644 patients (0.49%) undergoing cardiac surgery (valve procedures, n = 39; coronary artery bypass grafting, n = 13; coronary artery bypass grafting plus valve procedures, n = 4; heart transplantation, n = 4; and total aortic arch replacement, n = 2) required temporary postoperative ECMO support. During a follow-up study (mean 2.3 +/- 1.5 years, 100% complete), 32 were still alive and answered the Short-Form 36 Health Survey QOL questionnaire.Results. The mean duration of ECMO support was 61 +/- 37 hours. Forty patients (64.5%) were successfully weaned from ECMO. Thirty-four patients (54.8%) were discharged from the hospital after 44.3 +/- 17.6 days. The in-hospital mortality rate was 45.2% and the main cause of death was multiple organ failure. A risk factor for in-hospital death was a peak lactate level greater than 12 mol/L before ECMO initiation. There were few significant differences in the mean QOL scores between the ECMO survivors and other patients who had undergone cardiac surgery without ECMO support; only the measures of vitality and mental health were significantly lower in the ECMO survivors (p < 0.05). Both the ECMO survivors and the patients who did not receive ECMO support had significantly lower QOL scores (except for vitality and mental health) than the general Chinese population (p < 0.05).Conclusions. Extracorporeal membrane oxygenation is an acceptable technique for the treatment of postoperative cardiogenic shock in adults, although early intervention and reduced complications could improve results. However, the use of ECMO has little influence on QOL.