Intracranial Hemorrhage and Early Mortality in Patients Receiving Extracorporeal Membrane Oxygenation for Severe Respiratory Failure
Intracranial Hemorrhage and Early Mortality in Patients Receiving Extracorporeal Membrane Oxygenation for Severe Respiratory Failure
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DOI：
10.1055/s-0038-1636840
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发表时间：
2018-04-01
影响因子：
5.7
通讯作者：
Ledot, Stephane
中科院分区：
文献类型：
--
作者：
Arachchillage, Deepa R. J.;Passariello, Maurizio;Ledot, Stephane
颅内出血（ICH）是静脉-静脉体外膜氧合（VV-ECMO）患者的严重并发症，并与高死亡率相关。目前尚不清楚脑出血是ECMO的结果还是潜在疾病的结果。作者首先旨在评估颅内出血在VV-ECMO开始和过程中的发生率及其相关死亡率。第二个目的是确定临床和实验室措施，以预测脑出血在严重呼吸衰竭中的发展。数据收集自2012年1月至2016年12月在单一三级中心接受VV-ECMO治疗的165例患者，并根据单一方案进行治疗。只有在ECMO开始24小时内进行脑部计算机断层扫描的患者（n =149）被纳入分析。颅内出血在VV-ECMO开始时和过程中（中位9天）的患病率和发病率分别为10.7%（16/149）和5.2%（7/133）。血小板减少和肌酐清除率（CrCL）降低与入院时脑出血风险增加独立相关；优势比（95%置信区间）：22.6（2.6-99.5）和10.8（5.6-16.2）。入院时脑出血患者仅30天（非180天）死亡率显著高于未入院患者（37.5% [6/16]vs 16.4% [22/133]; p =0.03; 43.7% [7/16] vs 26.3% [35/133]; p =0.15）。在VV-ECMO开始时，CrCL降低和血小板减少与脑出血有关。颅内出血在开始时的高发生率表明它与潜在肺损伤的严重程度更密切相关，而不是与VV-ECMO本身。VV-ECMO开始时的脑出血与早期死亡率相关。
Intracranial hemorrhage (ICH) is a serious complication in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) and is associated with high mortality. It is unknown whether ICH may be a consequence of the ECMO or of an underlying disease. The authors first aimed to assess the incidence of ICH at initiation and during the course of VV-ECMO and its associated mortality. The second aim was to identify clinical and laboratory measures that could predict the development of ICH in severe respiratory failure. Data were collected from a total number of 165 patients receiving VV-ECMO from January, 2012 to December, 2016 in a single tertiary center and treated according to a single protocol. Only patients who had a brain computed tomography within 24 hours of initiation of ECMO ( n =149) were included for analysis. The prevalence and incidence of ICH at initiation and during the course of VV-ECMO (at median 9 days) were 10.7% (16/149) and 5.2% (7/133), respectively. Thrombocytopenia and reduced creatinine clearance (CrCL) were independently associated with increased risk of ICH on admission; odds ratio (95% confidence interval): 22.6 (2.6-99.5), and 10.8 (5.6-16.2). Only 30-day (not 180-day) mortality was significantly higher in patients with ICH on admission versus those without (37.5% [6/16] vs 16.4% [22/133]; p =0.03 and 43.7% [7/16] vs 26.3% [35/133]; p =0.15, respectively). Reduced CrCL and thrombocytopenia were associated with ICH at initiation of VV-ECMO. The higher incidence of ICH at initiation suggests it is more closely related to the severity of the underlying lung injury than to the VV-ECMO itself. ICH at VV-ECMO initiation was associated with early mortality.