Rastan A J, Lachmann N, Walther T, Doll N, Gradistanac T, Gommert J F, Lehmann S, Wittekind C, Mohr F W
University of Leipzig, Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
Int J Artif Organs. 2006 Dec;29(12):1121-31. doi: 10.1177/039139880602901205.
To assess the clinical sensitivity of causes of death, concomitant diseases and postoperative complications including thromboembolic events in ECMO patients.
Between January 2000 and December 2004 154/202 patients (76.2%) died after postcardiotomy ECMO circulatory support. Autopsy was performed in 78 (50.6%) consecutive patients. Clinical and post-mortem data were prospectively recorded and compared concerning causes of death and postoperative complications including venous and arterial thromboembolisms and significant comorbidities.
Mean age was 62.1+/-11.3 years, ejection fraction was 43.4+/-17.3%. 39.7% were emergency operations including acute coronary syndrome in 25.6% and preoperative cardiogenic shock in 28.2%. Successful ECMO weaning rate was 43.6%. Mean postoperative survival was 11.3 days. Premortem unknown concomitant diseases were found in 63 patients (80.8%) with clinical relevance in 9 patients (11.5%). Clinically unrecognized postoperative complications were found in 59 patients (75.6%) including acute cerebral infarction (n=7), acute bowel ischemia (1), intestinal perforation (3), pneumonia (4), venous thrombus formation (25) and systemic thromboembolic events (24). Clinically based causes of death were cardiac in 62.8%, multi-organ failure in 10.3%, cerebral in 5.1%, respiratory in 10.3%, fatal pulmonary embolism in 2.6%, technical in 5.1%, and others in 3.8%. Unexpected causes of death were found by autopsy in 22 patients (28.2%) including myocardial infarction (n=5), acute heart failure (4), fatal pulmonary embolism (2), pneumonia (2), ARDS (1), lung bleeding (1), fatal cerebrovascular event (4) and multiorgan failure (3).
In ECMO patients major discrepancies between clinical and post-mortem examination were found. The true incidence of thromboembolic events is highly underestimated by clinical evaluation.
评估体外膜肺氧合（ECMO）患者的死亡原因、伴随疾病及术后并发症（包括血栓栓塞事件）的临床敏感性。
2000年1月至2004年12月期间，154/202例（76.2%）患者在心脏术后接受ECMO循环支持后死亡。对78例（50.6%）连续患者进行了尸检。前瞻性记录并比较了临床和尸检数据，内容涉及死亡原因和术后并发症，包括静脉和动脉血栓栓塞以及严重合并症。
平均年龄为62.1±11.3岁，射血分数为43.4±17.3%。39.7%为急诊手术，其中25.6%为急性冠状动脉综合征，28.2%为术前心源性休克。成功脱离ECMO的比率为43.6%。术后平均生存时间为11.3天。63例患者（80.8%）存在生前未知的伴随疾病，其中9例（11.5%）具有临床相关性。59例患者（75.6%）存在临床未识别的术后并发症，包括急性脑梗死（7例）、急性肠缺血（1例）、肠穿孔（3例）、肺炎（4例）、静脉血栓形成（25例）和全身性血栓栓塞事件（24例）。基于临床的死亡原因中，心脏原因占62.8%，多器官功能衰竭占10.3%，脑部原因占5.1%，呼吸原因占10.3%，致命性肺栓塞占2.6%，技术原因占5.1%，其他原因占3.8%。尸检发现22例患者（28.2%）存在意外死亡原因，包括心肌梗死（5例）、急性心力衰竭（4例）、致命性肺栓塞（2例）、肺炎（2例）、急性呼吸窘迫综合征（ARDS，1例）、肺出血（1例）、致命性脑血管事件（4例）和多器官功能衰竭（3例）。
在ECMO患者中，临床检查与尸检结果存在重大差异。临床评估严重低估了血栓栓塞事件的真实发生率。
