Guodong Gao, Lin Lyu, Qiang Hu, Jinxiao Hu, Feilong Hei, Bingyan Ji, Kun Yu, Cun Long
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015 Dec;27(12):959-64. doi: 10.3760/cma.j.issn.2095-4352.2015.12.004.
To retrospectively review the clinical data of patients receiving extracorporeal membrane oxygenation (ECMO) during the last 10 years in Fuwai Hospital in order to assess the factors associated with the outcome of patients who had undergone ECMO, as well as to summarize the clinical experience, and to adopt a treatment strategy for future clinical decision.
The clinical data of adult patients undergoing ECMO admitted to Fuwai Hospital from December 2004 to December 2014 were retrospectively analyzed. Demographic characteristics, diagnosis, ECMO related data, including ECMO indication, operation, undergoing cardiopulmonary resuscitation (CPR) or not, and site of establishment, clinical parameters before and 24 hours after ECMO, duration of ECMO, and complications were collected to set up a database. The patients were divided into survival group and non-survival group according to the prognosis. The risk factors of mortality in hospital after ECMO were analyzed by logistic regression. RESULTS There were 142 adult patients who had received ECMO support, with 106 male and 36 female. All patients received veno-arterial ECMO (V-A ECMO). The indication of ECMO in 59 patients was unsuccessful weaning from extracorporeal circulation (41.5%), and that of 44 patients was low cardiac output cardiogenic shock (31.0%). CPR was necessary in 34 out of 142 patients undergoing ECMO. In 37 patients intra-aortic balloon pump (IABP) was necessary. ECMO was successfully weaned in 99 patients (69.7%), and 84 patients (59.2%) survived. The most frequent complication during ECMO support was bleeding from site of catheterization or operation (45.8%). Logistic regression revealed that high lactic acid levels [odds ratio (OR) = 1.469, 95% confidence interval (95%CI) = 1.170-1.843, P = 0.001] and high blood glucose (OR = 0.984, 95%CI = 0.969-0.999, P = 0.037) at 24 hours after ECMO, multiple organ dysfunction syndrome (MODS, OR = 17.243, 95%CI = 3.177-93.581, P = 0.001), gastrointestinal bleeding (OR = 8.774, 95%CI = 1.414-54.457, P = 0.020) were risk factors of in-hospital mortality in adult patients undergoing ECMO.
ECMO can provide effective auxiliary support in patients with respiratory and circulatory failure, which 'shows good clinical effect. Strict indication, timely ECMO support and sophisticated management are the keys to the success of ECMO. The most frequent complications during ECMO support is bleeding from site of catheterization or operation. High lactic acid levels at 24 hours after ECMO, MODS and gastrointestinal bleeding are predictors of in-hospital mortality in adult patients, and appropriate control of blood sugar was beneficial for the recovery of patients.
回顾性分析阜外医院近10年接受体外膜肺氧合（ECMO）治疗患者的临床资料，评估影响ECMO治疗患者预后的相关因素，总结临床经验，为今后临床决策提供治疗策略。
回顾性分析2004年12月至2014年12月在阜外医院接受ECMO治疗的成年患者的临床资料。收集患者的人口学特征、诊断、ECMO相关资料，包括ECMO适应证、手术情况、是否行心肺复苏（CPR）及置管部位，ECMO治疗前及治疗24小时后的临床参数、ECMO治疗时间及并发症等，建立数据库。根据预后将患者分为存活组和非存活组。采用Logistic回归分析ECMO治疗后患者院内死亡的危险因素。结果：142例接受ECMO支持的成年患者中，男性106例，女性36例。所有患者均接受静脉-动脉ECMO（V-A ECMO）治疗。59例（41.5%）患者ECMO的适应证为体外循环脱机困难，44例（31.0%）为低心排血量心源性休克。142例接受ECMO治疗的患者中，34例需要行CPR。37例患者需要行主动脉内球囊反搏（IABP）治疗。99例（69.7%）患者成功撤机，84例（59.2%）患者存活。ECMO支持期间最常见的并发症是置管部位或手术部位出血（45.8%）。Logistic回归分析显示，ECMO治疗24小时后高乳酸水平[比值比（OR）=1.469，95%置信区间（95%CI）=1.170-1.843，P=0.001]、高血糖（OR=0.984，95%CI=0.969-0.999，P=0.037）、多器官功能障碍综合征（MODS，OR=17.243，95%CI=3.177-93.581，P=0.001）、消化道出血（OR=8.774，95%CI=1.414-54.457，P=0.020）是成年ECMO治疗患者院内死亡的危险因素。
ECMO可为呼吸循环衰竭患者提供有效的辅助支持，临床效果良好。严格掌握适应证、及时行ECMO支持及精细管理是ECMO成功的关键。ECMO支持期间最常见的并发症是置管部位或手术部位出血。ECMO治疗24小时后高乳酸水平、MODS及消化道出血是成年患者院内死亡的预测因素，适当控制血糖有利于患者康复。
