Rückert Florian, Steinke Thomas, Flöther Lilit, Bucher Michael, Metz Dietrich, Frantz Stefan, Charitos Efstratios I, Treede Hendrik, Raspé Christoph
Department of Anesthesiology and Critical Care Medicine, Halle-Wittenberg University, Halle (Saale), Germany.
Department of Cardiac Surgery, Halle-Wittenberg University, Halle (Saale), Germany.
Interact Cardiovasc Thorac Surg. 2017 Apr 1;24(4):542-548. doi: 10.1093/icvts/ivw398.
Despite progress in the treatment of cardiopulmonary organ failure, the mortality rate for patients with acute respiratory distress syndrome (ARDS) and cardiogenic shock remains high. Extracorporeal membrane oxygenation (ECMO) is a promising treatment option, but long-term outcomes and health-related quality of life (HRQOL) are unknown.
Detailed information related to pre- and post-device data and outcomes from a consecutive sample of 71 patients treated with ECMO was analysed. Long-term survivors were given a detailed follow-up examination after a median time of 31 months that included multiple scoring systems for HRQOL assessment.
Seventy-one patients received a portable out-of-centre-implanted ECMO system. The survival rate at hospital discharge was 48%. Median HRQOL scores were 80% on the Karnofsky index (normal ≥80%), 80% on the Euroqol-5D (normal ≥75%) and 73.1% on the quality-of-life index (normal ≥70%). Mental scores were 96.7% on the Mini-Mental State Examination (normal ≥90.0%), 77.8% on the DemTect (normal ≥72.0%), 87.0% on the test for early detection of dementia with depression demarcation (TFDD; normal ≥74.0%) and confirmed good mental state and HRQOL for patients at follow-up. Univariate analysis for in-hospital mortality indicated that ventilation time before device implantation, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, higher lactate level at the time of ECMO implantation and female gender were associated with adverse outcomes.
In our cohort of patients, survivors of out-of-hospital ECMO implantation demonstrated good mental and quality-of-life conditions with well-recovered cardiopulmonary function during long-term follow-up. The indicators for adverse outcomes, pre-implantation lactate levels, pre-ventilation time and APACHE II score, should be considered before implantation of an ECMO device.
This study is registered at DRKS (Deutsches Register Klinischer Studien) under the code DRKS00009735 and was submitted to the WHO.
尽管心肺器官衰竭的治疗取得了进展，但急性呼吸窘迫综合征（ARDS）和心源性休克患者的死亡率仍然很高。体外膜肺氧合（ECMO）是一种有前景的治疗选择，但长期预后和健康相关生活质量（HRQOL）尚不清楚。
分析了71例接受ECMO治疗的连续样本患者的设备前后详细数据及预后相关信息。长期存活者在中位时间31个月后接受了详细的随访检查，包括用于HRQOL评估的多个评分系统。
71例患者接受了便携式院外植入式ECMO系统。出院时生存率为48%。HRQOL中位评分在卡氏指数上为80%（正常≥80%），在欧洲五维健康量表（Euroqol-5D）上为80%（正常≥75%），在生活质量指数上为73.1%（正常≥70%）。简易精神状态检查表上的精神评分是96.7%（正常≥90.0%），在德米特认知测试（DemTect）上为77.8%（正常≥72.0%），在伴有抑郁分界的痴呆早期检测测试（TFDD；正常≥74.0%）上为87.0%，随访时患者精神状态和HRQOL良好。住院死亡率的单因素分析表明，设备植入前的通气时间、较高的急性生理与慢性健康状况评估（APACHE）II评分、ECMO植入时较高的乳酸水平以及女性性别与不良预后相关。
在我们的患者队列中，院外ECMO植入的存活者在长期随访中表现出良好的精神和生活质量状况，心肺功能恢复良好。在植入ECMO设备前应考虑不良预后指标、植入前乳酸水平、通气前时间和APACHE II评分。
本研究已在德国临床试验注册中心（DRKS）注册，注册号为DRKS00009735，并已提交给世界卫生组织。
