心脏手术后长时间静脉体外膜氧合的特征和结果:心脏手术后体外生命支持(PELS-1)队列研究》。

IF 7.7 1区 医学 Q1 CRITICAL CARE MEDICINE Critical Care Medicine Pub Date : 2024-10-01 Epub Date: 2024-06-07 DOI:10.1097/CCM.0000000000006349
Jeroen J H Bunge, Silvia Mariani, Christiaan Meuwese, Bas C T van Bussel, Michele Di Mauro, Dominik Wiedeman, Diyar Saeed, Matteo Pozzi, Antonio Loforte, Udo Boeken, Robertas Samalavicius, Karl Bounader, Xiaotong Hou, Hergen Buscher, Leonardo Salazar, Bart Meyns, Daniel Herr, Sacha Matteucci, Sandro Sponga, Graeme MacLaren, Claudio Russo, Francesco Formica, Pranya Sakiyalak, Antonio Fiore, Daniele Camboni, Giuseppe Maria Raffa, Rodrigo Diaz, I-Wen Wang, Jae-Seung Jung, Jan Belohlavek, Vin Pellegrino, Giacomo Bianchi, Matteo Pettinari, Alessandro Barbone, José P Garcia, Kiran Shekar, Glenn J R Whitman, Diederik Gommers, Dinis Dos Reis Miranda, Roberto Lorusso
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引用次数: 0

摘要

目标:大多数开胸手术(PC)后体外膜肺氧合(ECMO)持续时间少于 7 天。关于更长时间运行的结果的研究结果相互矛盾。本研究调查了与 PC ECMO 持续时间相关的患者特征及短期和长期预后,重点关注长时间(> 7 天)ECMO:设计:回顾性观察队列研究:时间:2000 年 1 月至 2020 年 12 月,来自 16 个国家的 34 个中心:干预措施:无:干预措施:无:比较了按 ECMO 持续时间分类的患者的特征、院内和出院后结果。在 ECMO 持续时间超过 7 天的亚组患者中,对存活者和非存活者进行了比较。主要结果是院内死亡率。纳入的 221 名患者需要 PC ECMO 0-3 天(n = 649 [32.1%])、4-7 天(n = 776 [38.3%])、8-10 天(n = 263 [13.0%])和超过 10 天(n = 333 [16.5%])。各 ECMO 持续时间组的术前和手术特征没有重大差异。然而,ECMO持续时间较长的组别与多种并发症有关,包括出血、急性肾损伤、心律失常和败血症。医院死亡率呈 U 型曲线,ECMO 持续时间为 4-7 天的患者死亡率最低(394 人,50.8%),ECMO 支持时间超过 10 天的患者死亡率最高(242 人,72.7%)。不同 ECMO 持续时间组的出院后存活率无明显差异。在 ECMO 持续时间超过 7 天的患者中,年龄、合并症、瓣膜疾病和复杂手术与非存活率有关:近 30% 的 PC ECMO 患者支持时间超过 7 天。尽管出院后的长期预后与支持时间较短的 PC ECMO 患者相当,但支持 7 天后的院内死亡率增加,尤其是接受瓣膜和复杂手术或有并发症的患者。
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Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study.

Objectives: Most post-cardiotomy (PC) extracorporeal membrane oxygenation (ECMO) runs last less than 7 days. Studies on the outcomes of longer runs have provided conflicting results. This study investigates patient characteristics and short- and long-term outcomes in relation to PC ECMO duration, with a focus on prolonged (> 7 d) ECMO.

Design: Retrospective observational cohort study.

Setting: Thirty-four centers from 16 countries between January 2000 and December 2020.

Patients: Adults requiring post PC ECMO between 2000 and 2020.

Interventions: None.

Measurements and main results: Characteristics, in-hospital, and post-discharge outcomes were compared among patients categorized by ECMO duration. Survivors and nonsurvivors were compared in the subgroup of patients with ECMO duration greater than 7 days. The primary outcome was in-hospital mortality. Two thousand twenty-one patients were included who required PC ECMO for 0-3 days ( n = 649 [32.1%]), 4-7 days ( n = 776 [38.3%]), 8-10 days ( n = 263 [13.0%]), and greater than 10 days ( n = 333 [16.5%]). There were no major differences in the investigated preoperative and procedural characteristics among ECMO duration groups. However, the longer ECMO duration category was associated with multiple complications including bleeding, acute kidney injury, arrhythmias, and sepsis. Hospital mortality followed a U-shape curve, with lowest mortality in patients with ECMO duration of 4-7 days ( n = 394, 50.8%) and highest in patients with greater than 10 days ECMO support ( n = 242, 72.7%). There was no significant difference in post-discharge survival between ECMO duration groups. In patients with ECMO duration greater than 7 days, age, comorbidities, valvular diseases, and complex procedures were associated with nonsurvival.

Conclusions: Nearly 30% of PC ECMO patients were supported for greater than 7 days. In-hospital mortality increased after 7 days of support, especially in patients undergoing valvular and complex surgery, or who had complications, although the long-term post-discharge prognosis was comparable to PC ECMO patients with shorter support duration.

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来源期刊
Critical Care Medicine
Critical Care Medicine 医学-危重病医学
CiteScore
16.30
自引率
5.70%
发文量
728
审稿时长
2 months
期刊介绍: Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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