1 Department of Cardiology, University of California, Los Angeles, CA, USA.
2 Department of Surgery, University of California, Los Angeles, CA, USA.
J Intensive Care Med. 2018 May;33(5):288-295. doi: 10.1177/0885066616654451. Epub 2016 Jun 14.
Advances in extracorporeal membrane oxygenation (ECMO) have enabled rapid deployment in a wide range of clinical settings. We report our experience with venoarterial (VA) ECMO in adult patients over 10 years and aim to identify predictors of mortality.
This is a retrospective analysis of all adult patients undergoing VA ECMO at a tertiary care center from January 1, 2004, to December 31, 2013.
A total of 224 consecutive cases were reviewed. Eighty (35.7%) patients survived to discharge and 144 (64.3%) patients died. Patients requiring ECMO for heart transplant graft failure had lower mortality (51.6%) compared to all other etiologies (69.1%; P = .02). Forty-two percent (94 of the 224) of the patients required cardiopulmonary resuscitation (CPR) preceding ECMO and had higher rate of in-hospital mortality (74.5%) compared with patients without cardiac arrest (56.9%; P = .01). Patients with less than 30 minutes of CPR had a mortality rate of 40.0% compared to 91.4% for CPR > 30 minutes ( P = .001). In all, 24.1% of patients (54 of the 224) experienced ECMO-associated complications without significant increase in mortality, and 22.3% (50 of the 224) of the patients were transitioned to ventricular assist devices (VADs) or transplant. Patients bridged to a VAD including left ventricular assist devices and biventricular assist devices had a mortality rate of 56.1% versus 22.2% when bridged directly to transplant ( P = .01). Paradoxically, patients with an ejection fraction (EF) > 35% had a higher mortality compared to patients with an EF < 35% (75.3% vs 49.4%, respectively, P = .001).
Extracorporeal membrane oxygenation in patients with heart transplant graft failure had the best outcome. In patients who had cardiac arrest, prolonged CPR > 30 minutes was associated with very high mortality. Paradoxically, patients with EF > 35% had a higher mortality than patients with EF < 35%, likely reflecting patients with diastolic heart failure or noncardiac causes necessitating ECMO. For transplant candidates, direct bridge from ECMO to transplant could achieve a very good outcome.
体外膜肺氧合（ECMO）的进步使得其能够在广泛的临床环境中快速部署。我们报告了在一家三级医疗中心对成人患者使用静脉动脉（VA）ECMO 的 10 年经验，并旨在确定死亡率的预测因素。
这是对 2004 年 1 月 1 日至 2013 年 12 月 31 日在一家三级医疗中心接受 VA ECMO 的所有成年患者的回顾性分析。
共回顾了 224 例连续病例。80 例（35.7%）患者存活出院，144 例（64.3%）患者死亡。因心脏移植移植物衰竭而需要 ECMO 的患者死亡率较低（51.6%），与所有其他病因相比（69.1%；P=0.02）。224 例患者中有 42%（94 例）在接受 ECMO 前需要心肺复苏（CPR），院内死亡率较高（74.5%），与无心脏骤停的患者相比（56.9%；P=0.01）。CPR 时间少于 30 分钟的患者死亡率为 40.0%，而 CPR 时间大于 30 分钟的患者死亡率为 91.4%（P=0.001）。共有 24.1%的患者（224 例中的 54 例）出现 ECMO 相关并发症，但死亡率无显著增加，22.3%的患者（224 例中的 50 例）转为心室辅助设备（VAD）或移植。与直接移植相比，桥接至 VAD（包括左心室辅助设备和双心室辅助设备）的患者死亡率为 56.1%，而桥接至移植的患者死亡率为 22.2%（P=0.01）。矛盾的是，射血分数（EF）大于 35%的患者死亡率高于 EF 小于 35%的患者（分别为 75.3%和 49.4%，P=0.001）。
心脏移植移植物衰竭患者的体外膜肺氧合结果最佳。在有心脏骤停的患者中，CPR 时间大于 30 分钟与极高死亡率相关。矛盾的是，EF 大于 35%的患者死亡率高于 EF 小于 35%的患者，这可能反映了舒张性心力衰竭或需要 ECMO 的非心脏原因的患者。对于移植候选者，从 ECMO 直接桥接至移植可获得非常好的结果。
