在清醒的心源性休克患者中进行静脉-动脉体外生命支持的可行性。

0 CARDIAC & CARDIOVASCULAR SYSTEMS Interdisciplinary cardiovascular and thoracic surgery Pub Date : 2024-08-01 DOI:10.1093/icvts/ivae148
Iris Feng, Sameer Singh, Serge S Kobsa, Yanling Zhao, Paul A Kurlansky, Ashley Zhang, Anna J Vaynrub, Justin A Fried, Koji Takeda
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引用次数: 0

摘要

研究目的本研究旨在证明静脉-动脉体外生命支持(VA-ECLS)在未插管("清醒")的心源性休克患者中的效果,因为很少有研究对这一人群的安全性和可行性进行调查:这是对 2017 年至 2021 年我院连续 394 例 VA-ECLS 患者的回顾性研究。我们排除了因与插管明确相关的适应症而插管的患者。根据插管时的插管状态对患者进行分层,并通过逆治疗概率加权平衡基线差异。主要结果是院内死亡率,次要结果包括 ECLS 期间的不良事件和出院时的去向:在最终队列的 135 名患者中,79 人插管,56 人在插管时清醒。所有清醒患者均接受了经皮股骨插管,技术成功率为 100%,且未插管。清醒患者的 VA-ECLS 适应症包括急性失代偿性心力衰竭(64.3%)、肺动脉高压或大面积肺栓塞(12.5%)、心肌炎(8.9%)和急性心肌梗死(5.4%)。经调整后,清醒和插管患者的 ECLS 持续时间(7 天 vs 6 天,p = 0.19)、院内死亡率(39.6% vs 51.7%,p = 0.28)和各种不良事件发生率相似。在多变量分析中,插管状态不是90天死亡率的重要风险因素(HR [95% CI]:1.26 [0.64, 2.45],P = 0.51)。与插管患者相比,心脏移植(15.1% vs 4.9%)和心室辅助装置(17.4% vs 2.2%)是清醒患者出院时更常见的去向(P = 0.02):清醒 VA-ECLS 安全可行,对特定心源性休克患者的治疗效果与插管患者相当。
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Feasibility of veno-arterial extracorporeal life support in awake patients with cardiogenic shock.

Objectives: This study sought to demonstrate outcomes of veno-arterial extracorporeal life support (VA-ECLS) in non-intubated ('awake') patients with cardiogenic shock, as very few studies have investigated safety and feasibility in this population.

Methods: This was a retrospective review of 394 consecutive VA-ECLS patients at our institution from 2017 to 2021. We excluded patients cannulated for indications definitively associated with intubation. Patients were stratified by intubation status at time of cannulation and baseline differences were balanced by inverse probability of treatment weighting. The primary outcome was in-hospital mortality while secondary outcomes included adverse events during ECLS and destination at discharge.

Results: Out of 135 patients in the final cohort, 79 were intubated and 56 were awake at time of cannulation. All awake patients underwent percutaneous femoral cannulation with technical success of 100% without intubation. Indications for VA-ECLS in awake patients included acute decompensated heart failure (64.3%), pulmonary hypertension or massive pulmonary embolism (12.5%), myocarditis (8.9%) and acute myocardial infarction (5.4%). After adjustment, awake and intubated patients had similar ECLS duration (7 vs 6 days, P = 0.19), in-hospital mortality (39.6% vs 51.7%, P = 0.28), and rates of various adverse events. Intubation status was not a significant risk factor for 90-day mortality (hazard ratio [95% confidence interval]: 1.26 [0.64, 2.45], P = 0.51) in multivariable analysis. Heart transplantation (15.1% vs 4.9%) and ventricular assist device (17.4% vs 2.2%) were more common destinations at discharge in awake patients than intubated patients (P = 0.02).

Conclusions: Awake VA-ECLS is safe and feasible with comparable outcomes as intubated counterparts in select cardiogenic shock patients.

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