接受静脉-动脉体外膜肺氧合治疗的成年患者的院内神经系统并发症：体外生命支持组织登记处的结果

In-Hospital Neurologic Complications in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Organization Registry.

作者信息

Lorusso Roberto, Barili Fabio, Mauro Michele Di, Gelsomino Sandro, Parise Orlando, Rycus Peter T, Maessen Jos, Mueller Thomas, Muellenbach Raf, Belohlavek Jan, Peek Giles, Combes Alain, Frenckner Bjorn, Pesenti Antonio, Thiagarajan Ravi R

机构信息

1Cardio-Thoracic Surgery Department, Maastricht University Medical Centre, Maastricht, The Netherlands.2Cardiac Surgery Unit, Cardiac Surgery, Santa Croce Hospital, Cuneo, Italy.3Institute of Cardiology, University of L'Aquila, L'Aquila, Italy.4Extracorporeal Life Support Organization (ELSO), University of Michigan, Ann Arbor, MI.5Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany.6ECMO Department, University of Wurzburg, Wurzburg, Germany.7Coronary Care Unit, Cardiovascular Medicine, General Teaching Hospital, Charles University, Prague, Czech Republic.8Cardio-Thoracic Surgery Department, Glenfield Hospital, Leicester, United Kingdom.9Internal Medicine Intensive Care Unit, La Pitiè Hospital, Paris, France.10Division of Pediatric Surgery-Karolinska Hospital, Stockholm, Sweden.11Anesthesiology Department-University of Milan, San Gerardo Hospital, Monza, Italy.12Cardiac Intensive Care Unit, Boston Children's Hospital, Boston, MA.

出版信息

Crit Care Med. 2016 Oct;44(10):e964-72. doi: 10.1097/CCM.0000000000001865.

DOI:10.1097/CCM.0000000000001865

PMID:27340754

Abstract

OBJECTIVES

To elucidate the epidemiology, complication profiles, hospital outcome, and predisposing factors of CNS complications occurring during venoarterial extracorporeal membrane oxygenation in adults.

DESIGN

Retrospective analysis of the Extracorporeal Life Support Organization registry.

SETTING

Data reported to Extracorporeal Life Support Organization by 230 extracorporeal membrane oxygenation centers from 1992 to 2013.

PATIENTS

Patients more than 16 years old supported with a single-run of venoarterial extracorporeal membrane oxygenation.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We examined 4,522 adult patients supported with venoarterial extracorporeal membrane oxygenation and included in the Extracorporeal Life Support Organization registry. Venoarterial extracorporeal membrane oxygenation was used for cardiac dysfunction in 3,005 patients (66.5%), cardiopulmonary resuscitation in 877 patients (19.4%), and respiratory failure in 640 patients (14.1%), respectively. Multivariate logistic regression was performed to identify factors independently associated with CNS injury. Neurologic complications occurred in 682 patients (15.1%), and included brain death in 358 patients (7.9%), cerebral infarction in 161 patients (3.6%), seizures in 83 patients (1.8%), and cerebral hemorrhage in 80 patients (1.8%). Multiple CNS complications in the same patient occurred in 70 cases. Hospital mortality in patients with CNS complications was 89%, compared with 57% in patients without (p < 0.001). In a multivariable model, age, pre-extracorporeal membrane oxygenation cardiac arrest, the use of inotropes on extracorporeal membrane oxygenation, and post-extracorporeal membrane oxygenation hypoglycemia were shown to be associated with CNS complications.

CONCLUSIONS

Neurologic complications in adult patients on venoarterial extracorporeal membrane oxygenation support are common and associated with poor survival. Further research should focus on better understanding and management of brain/extracorporeal membrane oxygenation interaction to avoid such catastrophic complications.

摘要

目的

阐明成人体外膜肺氧合（ECMO）期间发生中枢神经系统（CNS）并发症的流行病学、并发症类型、住院结局及易感因素。

设计

对体外生命支持组织（ELSO）登记处的数据进行回顾性分析。

地点

1992年至2013年期间，230个体外膜肺氧合中心向体外生命支持组织报告的数据。

患者

接受单次静脉-动脉体外膜肺氧合支持的16岁以上患者。

干预措施

无。

测量指标及主要结果

我们检查了4522例接受静脉-动脉体外膜肺氧合支持并纳入体外生命支持组织登记处的成年患者。静脉-动脉体外膜肺氧合分别用于3005例（66.5%）心脏功能不全患者、877例（19.4%）心肺复苏患者和640例（14.1%）呼吸衰竭患者。进行多因素逻辑回归分析以确定与中枢神经系统损伤独立相关的因素。682例患者（15.1%）发生神经系统并发症，其中358例（7.9%）为脑死亡，161例（3.6%）为脑梗死，83例（1.8%）为癫痫发作，80例（1.8%）为脑出血。70例患者出现多种中枢神经系统并发症。发生中枢神经系统并发症患者的住院死亡率为89%，未发生并发症患者为57%（p<0.001）。在多变量模型中，年龄、体外膜肺氧合前心脏骤停、体外膜肺氧合期间使用血管活性药物以及体外膜肺氧合后低血糖与中枢神经系统并发症相关。