Omar Hesham R, Mirsaeidi Mehdi, Mangar Devanand, Camporesi Enrico M
From the *Internal Medicine Department, Mercy Medical Center, Clinton, Iowa; †Division of Pulmonary, Critical Care, Sleep and Allergy, University of Miami, Miller School of Medical, Miami, Florida; ‡Section of Pulmonary, Department of Medicine, Miami VA Medical Center, Miami, Florida; §Tampa General Hospital, Tampa, Florida; ¶Department of Anesthesiology, TEAMHealth, Tampa, Florida; and ‖University of South Florida, Tampa, Florida.
ASAIO J. 2016 Sep-Oct;62(5):634-6. doi: 10.1097/MAT.0000000000000368.
We assessed the incidence and predictors of intracranial hemorrhage (ICH) occurring during extracorporeal membrane oxygenation (ECMO) support. Of 154 patients who received ECMO, 12 (7.8%) developed ICH. Patients with ICH had a longer ECMO duration (9.41 vs. 5.37 days, p = 0.007), and higher activated clotting time (activated clotting time, p= 0.016). They also experienced higher frequency of bleeding at other sites (p = 0.017) and required more platelet transfusion (p = 0.016). Multivariate analysis showed that a longer ECMO duration (odds ratio [OR] = 1.074, 95% confidence interval [CI] = 1.005-1.148, p = 0.035) is independently associated with the risk of ICH. We recommend routine neurological checks, monitoring of coagulation parameters, and attempt earlier rather than late weaning from ECMO whenever feasible.
我们评估了体外膜肺氧合（ECMO）支持期间颅内出血（ICH）的发生率及预测因素。在接受ECMO治疗的154例患者中，12例（7.8%）发生了ICH。发生ICH的患者ECMO持续时间更长（9.41天对5.37天，p = 0.007），活化凝血时间更高（活化凝血时间，p = 0.016）。他们在其他部位出血的频率也更高（p = 0.017），并且需要更多的血小板输注（p = 0.016）。多因素分析显示，较长的ECMO持续时间（比值比[OR]=1.074，95%置信区间[CI]=1.005 - 1.148，p = 0.035）与ICH风险独立相关。我们建议进行常规神经学检查、监测凝血参数，并在可行时尽早而非延迟撤离ECMO。
