Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH 44195, USA.
J Cardiothorac Vasc Anesth. 2010 Dec;24(6):946-51. doi: 10.1053/j.jvca.2010.03.020.
The authors analyzed hospital mortality in adult cardiac surgery patients who required postoperative venoarterial extracorporeal membrane oxygenation (ECMO) support for circulatory failure and identified perioperative patient variables associated with hospital mortality in these patients.
A retrospective study.
A single institution, tertiary academic center.
Adult patients requiring venoarterial ECMO support after cardiac surgery from January 1995 to December 2005 were identified from the Anesthesiology Institute Patient Registry. Twenty-two preselected patient variables were entered into a logistic regression model of hospital death.
None.
Two hundred thirty-three of 40,116 (0.58%) adult cardiac surgery patients required postoperative venoarterial ECMO, and among these, 149 (64%) died in the hospital. In an unadjusted analysis, older age, higher preoperative albumin, diabetes history, coronary artery bypass graft surgery, and longer total cardiopulmonary bypass (CPB) time were associated with increased hospital mortality, and a history of cardiogenic shock was associated with decreased mortality. In an adjusted logistic regression analysis, a history of cardiogenic shock and younger age were associated with decreased hospital mortality. The overall use of postoperative venoarterial ECMO in this patient population decreased since its peak in 1996.
Venoarterial ECMO support after cardiac surgery was required in a small fraction of patients and was associated with very high hospital mortality; but among those requiring ECMO, mortality in these patients was lower in younger, nondiabetic patients with cardiogenic shock who had shorter CPB times. The mortality associated patient variables identified are not easily modifiable and do not appear sufficiently robust to define which patients should be selected for this potentially life-saving therapy.
作者分析了因循环衰竭而需要术后静脉动脉体外膜肺氧合（ECMO）支持的成年心脏手术患者的院内死亡率，并确定了这些患者与院内死亡率相关的围手术期患者变量。
回顾性研究。
一个机构，三级学术中心。
从 1995 年 1 月至 2005 年 12 月，从麻醉学研究所患者登记处确定了在心脏手术后需要静脉动脉 ECMO 支持的成年患者。22 个预先选择的患者变量被输入到医院死亡的逻辑回归模型中。
无。
在 40116 例成年心脏手术患者中，有 233 例（0.58%）需要术后静脉动脉 ECMO，其中 149 例（64%）在医院死亡。在未调整的分析中，年龄较大、术前白蛋白较高、糖尿病史、冠状动脉旁路移植术和总体外循环（CPB）时间较长与医院死亡率增加相关，而心源性休克史与死亡率降低相关。在调整后的逻辑回归分析中，心源性休克史和年龄较小与降低的医院死亡率相关。自 1996 年达到峰值以来，该患者人群中术后静脉动脉 ECMO 的总体使用率有所下降。
心脏手术后需要静脉动脉 ECMO 支持的患者比例很小，但与极高的医院死亡率相关；但在需要 ECMO 的患者中，心源性休克、CPB 时间较短、无糖尿病的年轻患者死亡率较低。确定的与死亡率相关的患者变量不易改变，并且似乎不足以确定哪些患者应选择这种潜在的救命治疗。
