静脉-静脉体外生命支持可提高急性低氧性呼吸衰竭成人创伤患者的生存率：一项多中心回顾性队列研究。
Venovenous extracorporeal life support improves survival in adult trauma patients with acute hypoxemic respiratory failure: a multicenter retrospective cohort study.
机构信息
From the Wake Forest School of Medicine (D.M.G., B.S.S., R.S.M., T.P.), Winston-Salem, North Carolina; Los Angeles County + University of Southern California Medical Center (O.T.O., N.J.M., K.I.), Los Angeles, California; US Army Institute of Surgical Research (J.K.A.); University of Texas Health Science Center at San Antonio, (R.C.F.); and San Antonio Military Medical Center (J.W.C.), San Antonio; University of Texas Health Science Center at Houston (M.H.H.), Houston, Texas; Norman M. Rich Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland.
出版信息
J Trauma Acute Care Surg. 2014 May;76(5):1275-81. doi: 10.1097/TA.0000000000000213.
BACKGROUND
Venovenous extracorporeal life support (VV ECLS) has been reported in adult trauma patients with severe respiratory failure; however, ECLS is not available in many trauma centers, few trauma surgeons have experience initiating ECLS and managing ECLS patients, and there is currently little evidence supporting its use in severely injured patients. This study seeks to determine if VV ECLS improves survival in such patients.
METHODS
Data from two American College of Surgeons-verified Level 1 trauma centers, which maintain detailed records of patients with acute hypoxemic respiratory failure (AHRF), were evaluated retrospectively. The study population included trauma patients between 16 years and 55 years of age treated for AHRF between January 2001 and December 2009. These patients were divided into two cohorts as follows: patients who received VV ECLS after an incomplete or no response to other rescue therapies (ECLS) versus patients who were managed with mechanical ventilation (CONV). The primary outcome was survival to discharge, and secondary outcomes were intensive care unit and hospital length of stay (LOS), total ventilator days, and rate of complications requiring intervention.
RESULTS
Twenty-six ECLS patients and 76 CONV patients were compared. Adjusted survival was greater in the ECLS group (adjusted odds ratio, 0.193; 95% confidence interval, 0.042-0.884; p = 0.034). Ventilator days, intensive care unit LOS, and hospital LOS did not differ between the groups. ECLS patients received more blood transfusions and had more bleeding complications, while the CONV patients had more pulmonary complications. A cohort of 17 ECLS and 17 CONV patients matched for age and lung injury severity also demonstrated a significantly greater survival in the ECLS group (adjusted odds ratio, 0.038; 95% confidence interval, 0.004-0.407; p = 0.007).
CONCLUSION
VV ECLS is independently associated with survival in adult trauma patients with AHRF. ECLS should be considered in trauma patients with AHRF when conventional therapies prove ineffective; if ECLS is not readily available, transfer to an ECLS center should be pursued.
LEVEL OF EVIDENCE
Therapeutic study, level III.
背景
静脉-静脉体外生命支持（VV ECLS）已在患有严重呼吸衰竭的成年创伤患者中报告；然而，许多创伤中心没有 ECLS，很少有创伤外科医生有启动 ECLS 和管理 ECLS 患者的经验，目前几乎没有证据支持其在严重受伤患者中的使用。本研究旨在确定 VV ECLS 是否能提高此类患者的生存率。
方法
回顾性评估了两家经美国外科医师学院验证的 1 级创伤中心的数据，这些中心详细记录了急性低氧性呼吸衰竭（AHRF）患者的资料。研究人群包括 2001 年 1 月至 2009 年 12 月期间因 AHRF 接受治疗的年龄在 16 岁至 55 岁之间的创伤患者。这些患者分为两组：对其他抢救治疗无反应或反应不完全的患者接受 VV ECLS（ECLS）治疗，以及接受机械通气（CONV）治疗的患者。主要结局是出院时的生存率，次要结局是重症监护病房和医院的住院时间（LOS）、总呼吸机天数和需要干预的并发症发生率。
结果
比较了 26 例 ECLS 患者和 76 例 CONV 患者。ECLS 组的调整后生存率更高（调整后的优势比，0.193；95%置信区间，0.042-0.884；p = 0.034）。两组患者的呼吸机天数、重症监护病房 LOS 和医院 LOS 无差异。ECLS 患者接受了更多的输血，并出现更多的出血并发症，而 CONV 患者出现了更多的肺部并发症。年龄和肺损伤严重程度相匹配的 17 例 ECLS 和 17 例 CONV 患者的队列也显示 ECLS 组的生存率显著更高（调整后的优势比，0.038；95%置信区间，0.004-0.407；p = 0.007）。
结论
VV ECLS 与成年创伤患者 AHRF 的生存率独立相关。在常规治疗无效时，应考虑在创伤患者 AHRF 中使用 ECLS；如果 ECLS 不可用，应寻求转移到 ECLS 中心。
证据水平
治疗研究，III 级。
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