Gastrointestinal Bleeding in Extracorporeal Membrane Oxygenation Patients: A Comprehensive Analysis of Risk Factors and Clinical Outcomes.

Q4 Medicine Journal of Chest Surgery Pub Date : 2024-03-05 Epub Date: 2024-02-08 DOI:10.5090/jcs.23.136
Sahri Kim, Jung Hyun Lim, Ho Hyun Ko, Lyo Min Kwon, Hong Kyu Lee, Yong Joon Ra, Kunil Kim, Hyoung Soo Kim
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Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is an intervention for severe heart and lung failure; however, it poses the risk of complications, including gastrointestinal bleeding (GIB). Comprehensive analyses of GIB in patients undergoing ECMO are limited, and its impact on clinical outcomes remains unclear.

Methods: This retrospective study included 484 patients who received venovenous and venoarterial ECMO between January 2015 and December 2022. Data collected included patient characteristics, laboratory results, GIB details, and interventions. Statistical analyses were performed to identify risk factors and assess the outcomes.

Results: GIB occurred in 44 of 484 patients (9.1%) who received ECMO. Multivariable analysis revealed that older age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.06; p=0.0130) and need to change the ECMO mode (OR, 3.74; 95% CI, 1.75-7.96; p=0.0006) were significant risk factors for GIB, whereas no association was found with antiplatelet or systemic anticoagulation therapies during ECMO management. Half of the patients with GIB (22/44, 50%) underwent intervention, with endoscopy as the primary modality (19/22, 86.4%). Patients who underwent ECMO and developed GIB had higher rates of mortality (40/44 [90.9%] vs. 262/440 [59.5%]) and ECMO weaning failure (38/44 [86.4%] vs. 208/440 [47.3%]).

Conclusion: GIB in patients undergoing ECMO is associated with adverse outcomes, including increased risks of mortality and weaning failure. Even in seemingly uncomplicated cases, it is crucial to avoid underestimating the significance of GIB.

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体外膜氧合患者的消化道出血:风险因素和临床结果的综合分析。
背景:体外膜肺氧合(ECMO)是治疗严重心肺功能衰竭的一种干预措施;然而,它也存在并发症的风险,包括消化道出血(GIB)。对接受 ECMO 患者胃肠道出血的全面分析有限,其对临床结果的影响仍不明确:这项回顾性研究纳入了 2015 年 1 月至 2022 年 12 月期间接受静脉和静脉动脉 ECMO 的 484 名患者。收集的数据包括患者特征、实验室结果、GIB详情和干预措施。通过统计分析确定风险因素并评估结果:484名接受ECMO的患者中有44名(9.1%)发生了GIB。多变量分析显示,年龄较大(几率比[OR],1.04;95% 置信区间[CI],1.01-1.06;P=0.0130)和需要改变 ECMO 模式(OR,3.74;95% CI,1.75-7.96;P=0.0006)是 GIB 的显著风险因素,而与 ECMO 管理期间的抗血小板或全身抗凝疗法无关。半数 GIB 患者(22/44,50%)接受了介入治疗,内镜检查是主要方式(19/22,86.4%)。接受 ECMO 并发生 GIB 的患者死亡率较高(40/44 [90.9%] vs. 262/440 [59.5%]),ECMO 断流失败率较高(38/44 [86.4%] vs. 208/440 [47.3%]):结论:接受 ECMO 患者的 GIB 与不良预后有关,包括死亡率和断流失败的风险增加。即使在看似不复杂的病例中,也必须避免低估 GIB 的重要性。
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来源期刊
Journal of Chest Surgery
Journal of Chest Surgery Medicine-Surgery
CiteScore
0.80
自引率
0.00%
发文量
76
审稿时长
7 weeks
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