Saxena Pankaj, Neal James, Joyce Lyle D, Greason Kevin L, Schaff Hartzell V, Guru Pramod, Shi William Y, Burkhart Harold, Li Zhuo, Oliver William C, Pike Roxann B, Haile Dawit T, Schears Gregory J
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Perfusion Services, Mayo Clinic, Rochester, Minnesota.
Ann Thorac Surg. 2015 Jun;99(6):2053-60. doi: 10.1016/j.athoracsur.2014.11.075. Epub 2015 Apr 10.
We conducted a retrospective study to assess whether providing extracorporeal membrane oxygenation (ECMO) support to elderly patients (aged 70 years or more) who failed separation from cardiopulmonary bypass after cardiac surgery was a viable option.
From 2003 to 2013, 45 patients aged 70 years or more underwent 47 runs of ECMO postoperatively.
There were 31 men (68.9%). The mean age was 76.8 years. Five patients were in cardiogenic shock preoperatively. Forty-four patients required venoarterial ECMO support for cardiogenic shock. Mean duration of support was 103.8 ± 74.3 hours. Twenty-one patients (46.6%) died while on ECMO support. Twenty-four patients (53.3%) were weaned off ECMO initially, and 11 patients were discharged from hospital. Inhospital mortality was 75.6%. Postoperative complications included acute kidney injury in 30 patients (44.4%), pneumonia in 12 (26.7%), and sepsis in 11 (24.4%). There were 30 deaths (88.2%) attributable to cardiac causes. Preoperative atrial fibrillation, chronic kidney injury, lactic acidosis on ECMO support, and persistent coagulopathy were associated with higher mortality.
Postcardiotomy ECMO support in elderly patients is associated with high postoperative morbidity and mortality. Nevertheless, it often provides the last line of therapy for these critically ill patients and may provide positive outcomes in selected subgroups.
我们进行了一项回顾性研究，以评估对心脏手术后体外循环脱机失败的老年患者（70岁及以上）提供体外膜肺氧合（ECMO）支持是否是一种可行的选择。
2003年至2013年，45例70岁及以上的患者术后接受了47次ECMO治疗。
男性31例（68.9%）。平均年龄为76.8岁。5例患者术前出现心源性休克。44例患者因心源性休克需要静脉-动脉ECMO支持。平均支持时间为103.8±74.3小时。21例患者（46.6%）在ECMO支持期间死亡。24例患者（53.3%）最初成功撤机，11例患者出院。住院死亡率为75.6%。术后并发症包括30例急性肾损伤（44.4%）、12例肺炎（26.7%）和11例脓毒症（24.4%）。30例死亡（88.2%）归因于心脏原因。术前房颤、慢性肾损伤、ECMO支持期间的乳酸酸中毒和持续性凝血病与较高的死亡率相关。
老年患者心脏术后ECMO支持与术后高发病率和死亡率相关。然而，它通常为这些重症患者提供了最后一线治疗，并且可能在选定的亚组中产生积极的结果。
