Muñoz Javier, Santa-Teresa Patricia, Tomey María Jesus, Visedo Lourdes Carmen, Keough Elena, Barrios Juan Camilo, Sabell Santiago, Morales Antonio
ICU, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
ICU, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
Heart Lung. 2017 Mar-Apr;46(2):100-105. doi: 10.1016/j.hrtlng.2017.01.003. Epub 2017 Feb 16.
To evaluate the development of an extracorporeal membrane oxygenation (ECMO) program for the treatment of acute respiratory distress syndrome (ARDS) in adults.
a) Descriptive study of 15 cases treated since the program approval from 2010 to 2016. b) Case-control study matching the 15 ECMO cases with the 52 severe ARDS treated between 2005 and 2011 in which alternative rescue treatments (prone ventilation, tracheal gas insufflation (TGI) and/or the administration of inhaled nitric oxide (iNO)) were used.
ECMO experience: Mortality 47% (7/15). Four patients died due to complications directly related to ECMO therapy. ICU stay 46.6 ± 45 days (range 4-138). Hospital stay 72.4 ± 98 days (range 4-320). Case-control: The mortality in the control group was 77% (44/52). The ECMO group practically doubled the mean days of ICU and hospital stay (p < 0.05). The multivariate analysis demonstrated an OR of 0.13 (0.02-0.73) for mortality associated with ECMO treatment. The following were also independent predictors of mortality: age (OR 1.05, 95% CI 1-11), SOFA score (OR 1.34, 95% CI 1.04-1.7), and the need for renal replacement therapy (OR 1.3, 95% CI 1.04-1.7). Economic analysis: The hospital cost per patient in the ECMO group doubled compared to that of the control group (USD 77,099 vs USD 37,660). However, the cost per survivor was reduced by 4% (USD 144,560 vs USD 150,640, respectively).
Our results endorse the use of ECMO as a rescue therapy in adults with ARDS, although there are some risks associated with a learning curve as well as an important increase in the days of patient stay. The justification for the maintenance of an ECMO program in adults should be based on future studies of efficacy and cost effectiveness.
评估用于治疗成人急性呼吸窘迫综合征（ARDS）的体外膜肺氧合（ECMO）项目的开展情况。
a）对自2010年项目获批至2016年期间治疗的15例患者进行描述性研究。b）病例对照研究，将15例接受ECMO治疗的患者与2005年至2011年期间治疗的52例重症ARDS患者进行匹配，后者采用了替代抢救治疗方法（俯卧位通气、气管内气体注入（TGI）和/或吸入一氧化氮（iNO））。
ECMO治疗经验：死亡率47%（7/15）。4例患者死于与ECMO治疗直接相关的并发症。重症监护病房（ICU）住院时间为46.6±45天（范围4 - 138天）。住院时间为72.4±98天（范围4 - 320天）。病例对照研究：对照组死亡率为77%（44/52）。ECMO组的ICU和住院平均天数几乎增加了一倍（p < 0.05）。多因素分析显示，与ECMO治疗相关的死亡的比值比（OR）为0.13（0.02 - 0.73）。以下因素也是死亡率的独立预测因素：年龄（OR 1.05，95%可信区间1 - 1.1）、序贯器官衰竭评估（SOFA）评分（OR 1.34，95%可信区间1.04 - 1.7）以及肾脏替代治疗需求（OR 1.3，95%可信区间1.04 - 1.7）。经济分析：ECMO组每位患者的住院费用相比对照组增加了一倍（77,099美元对37,660美元）。然而，每位幸存者的费用降低了4%（分别为144,560美元对150,640美元）。
我们的结果支持将ECMO用作成人ARDS的抢救治疗方法，尽管存在与学习曲线相关的一些风险以及患者住院天数的显著增加。维持成人ECMO项目的合理性应基于未来的疗效和成本效益研究。
