Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis.
Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis.
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DOI：
10.1007/s00134-021-06593-x
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发表时间：
2022-03
影响因子：
38.9
通讯作者：
Grandin, E. Wilson
中科院分区：
文献类型：
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作者：
Nunez, Jose, I;Gosling, Andre F.;O'Gara, Brian;Kennedy, Kevin F.;Rycus, Peter;Abrams, Darryl;Brodie, Daniel;Shaefi, Shahzad;Garan, A. Reshad;Grandin, E. Wilson
本研究旨在分析成人静脉-静脉体外膜氧合（VV-ECMO）支持下出血和血栓形成事件（BTEs）的患病率、死亡率关联和危险因素。我们查询了2010年至2017年接受VV-ECMO支持的成人体外生命支持组织（Extracorporeal Life Support Organization）登记。采用多变量logistic回归模型评估脑负荷负荷与住院死亡率之间的关系以及脑负荷负荷的预测因子。在符合标准的7579例VV-ECMO患者中，40.2%的患者BTE≥1。血栓事件占所有bte的54.9%，主要是ECMO回路血栓形成。BTE率在研究期间显著下降（p < 0.001）。住院死亡率为34.9%。出血事件（1.69[1.49-1.93]）与住院死亡率的相关性高于血栓事件（1.23[1.08-1.41]），两者p < 0.01。与死亡率相关性最强的是缺血性脑卒中（4.50[2.55-7.97]）和内科出血，包括颅内出血（5.71[4.02-8.09]）、肺出血（2.02[1.54 - 2.67]）和胃肠道出血（1.54 [1.2-1.98]），p均< 0.01。出血的危险因素包括急性肾损伤和ECMO前血管加压剂支持，血栓形成的危险因素包括体重增加、多部位插管、ECMO前骤停和ECMO开始时PaCO2升高。较长的ECMO时间、较年轻、较高的pH值和较早的支持年份与出血和血栓形成有关。虽然随着时间的推移而减少，但bte在VV-ECMO期间仍然很常见，并且与院内死亡率有很强的累积关联。血栓性事件更频繁，但出血有更高的住院死亡率风险。存在出血和血栓并发症的不同危险因素，提高了VV-ECMO管理的量身定制方法的可能性。
This study aimed at analyzing the prevalence, mortality association, and risk factors for bleeding and thrombosis events (BTEs) among adults supported with venovenous extracorporeal membrane oxygenation (VV-ECMO). We queried the Extracorporeal Life Support Organization registry for adults supported with VV-ECMO from 2010 to 2017. Multivariable logistic regression modeling was used to assess the association between BTEs and in-hospital mortality and the predictors of BTEs. Among 7579 VV-ECMO patients meeting criteria, 40.2% experienced ≥ 1 BTE. Thrombotic events comprised 54.9% of all BTEs and were predominantly ECMO circuit thrombosis. BTE rates decreased significantly over the study period (p < 0.001). The inpatient mortality rate was 34.9%. Bleeding events (1.69 [1.49–1.93]) were more strongly associated with in-hospital mortality than thrombotic events (1.23 [1.08–1.41]) p < 0.01 for both. The BTEs most strongly associated with mortality were ischemic stroke (4.50 [2.55–7.97]) and medical bleeding, including intracranial (5.71 [4.02–8.09]), pulmonary (2.02 [1.54–2.67]), and gastrointestinal (1.54 [1.2–1.98]) hemorrhage, all p < 0.01. Risk factors for bleeding included acute kidney injury and pre-ECMO vasopressor support and for thrombosis were higher weight, multisite cannulation, pre-ECMO arrest, and higher PaCO2 at ECMO initiation. Longer time on ECMO, younger age, higher pH, and earlier year of support were associated with bleeding and thrombosis. Although decreasing over time, BTEs remain common during VV-ECMO and have a strong, cumulative association with in-hospital mortality. Thrombotic events are more frequent, but bleeding carries a higher risk of inpatient mortality. Differential risk factors for bleeding and thrombotic complications exist, raising the possibility of a tailored approach to VV-ECMO management.
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DOI：
10.1097/pcc.0000000000000317
发表时间：
2015-02
期刊：
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
影响因子：
--
作者：
Dalton HJ;Garcia-Filion P;Holubkov R;Moler FW;Shanley T;Heidemann S;Meert K;Berg RA;Berger J;Carcillo J;Newth C;Harrison R;Doctor A;Rycus P;Dean JM;Jenkins T;Nicholson C;Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network
通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network
影响因子：
8.2
作者：
An SJ;Kim TJ;Yoon BW
通讯作者：
Yoon BW
影响因子：
8.8
作者：
Cooper, Eve;Burns, Janis;Barrett, Nicholas A.
通讯作者：
Barrett, Nicholas A.
影响因子：
8.8
作者：
Aubron, Cecile;McQuilten, Zoe;Cooper, D. James
通讯作者：
Cooper, D. James
影响因子：
8.1
作者：
Aubron, Cecile;DePuydt, Joris;McQuilten, Zoe
通讯作者：
McQuilten, Zoe