Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
J Thorac Cardiovasc Surg. 2017 Aug;154(2):469-477.e2. doi: 10.1016/j.jtcvs.2017.02.055. Epub 2017 Mar 11.
Extracorporeal membrane oxygenation (ECMO) is a widely used technique for treating postcardiotomy cardiogenic shock (PCS); however, no study has compared the long-term outcomes of patients who receive ECMO support for PCS with those of the general population post cardiac surgery.
A total of 1141 patients who received ECMO after cardiac surgery between 2000 and 2011 were identified by using the Taiwan National Health Insurance Research Database. For each patient, we matched 5 non-ECMO patients who had undergone cardiac surgery by using propensity scores calculated for age, sex, 12 comorbid diseases, Charlson score, hospital level, type of cardiac surgery, and year of index hospitalization. The outcomes included all-cause mortality, readmission for any cause, and medical expenditure.
The incidence of ECMO use after cardiac surgery in Taiwan was 1.91%. The ECMO group had a significantly higher risk of in-hospital mortality than did the non-ECMO group (61.7% vs 6.8%, odds ratio 22.34, 95% confidence interval 19.06-26.18). The risks of all-cause mortality and first readmission for any cause were greater in the ECMO group than that in the control group (P < .001, P < .001) in the first year, whereas no difference was observed after the first year of follow-up (P = .209, P = .474). Similar results were observed regarding the medical expenditure of admission after index admission discharge.
Patients receiving ECMO for PCS had similar outcomes to those of the non-ECMO group after the first year of follow-up despite significantly poor outcomes during the in-hospital course.
体外膜肺氧合（ECMO）是一种广泛用于治疗心脏手术后心源性休克（PCS）的技术；然而，尚无研究比较接受 ECMO 支持治疗 PCS 的患者与心脏手术后一般人群的长期结局。
通过使用台湾全民健康保险研究数据库，确定了 2000 年至 2011 年间接受 ECMO 治疗的 1141 例心脏手术后患者。对于每位患者，我们通过计算年龄、性别、12 种合并症、Charlson 评分、医院级别、心脏手术类型和索引住院年份的倾向评分，匹配了 5 例接受心脏手术但未接受 ECMO 治疗的患者。结果包括全因死亡率、任何原因的再入院率和医疗支出。
台湾心脏手术后 ECMO 的使用率为 1.91%。ECMO 组住院期间死亡率明显高于非 ECMO 组（61.7% vs 6.8%，优势比 22.34，95%置信区间 19.06-26.18）。ECMO 组的全因死亡率和首次任何原因再入院率均高于对照组（P<0.001，P<0.001），但在随访第 1 年后，差异无统计学意义（P=0.209，P=0.474）。索引住院出院后再次入院的医疗支出也观察到类似的结果。
尽管在住院期间的结果明显较差，但接受 ECMO 治疗 PCS 的患者在随访第 1 年后的结局与非 ECMO 组相似。
