1Service de Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.2Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.3Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
Crit Care Med. 2017 Aug;45(8):1359-1366. doi: 10.1097/CCM.0000000000002485.
Long-term outcomes of patients treated with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure (i.e., cardiogenic shock complicating chronic cardiomyopathy) have not yet been reported. This study was undertaken to describe their outcomes and determine mortality-associated factors.
Retrospective analysis of data prospectively collected.
Twenty-six-bed tertiary hospital ICU.
One hundred five patients implanted with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure.
None.
From March 2007 to January 2015, 105 patients were implanted with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure in our ICU (67% of them had an intraaortic balloon pump to unload the left ventricle). Their 1-year survival rate was 42%; most of the survivors were transplanted either directly or after switching to central bilateral centrifugal pump, ventricular-assist device, or total artificial heart. Most deaths occurred early after multiple organ failure. Multivariable analyses retained (odds ratio [95% CI]) pre-extracorporeal membrane oxygenation Sequential Organ Failure Assessment score of more than 11 (3.3 [1.3-8.3]), idiopathic cardiomyopathy (0.4 [0.2-1]), cardiac disease duration greater than 2 years pre-extracorporeal membrane oxygenation (2.8 [1.2-6.9]), and pre-extracorporeal membrane oxygenation blood lactate greater than 4 mmol/L (2.6 [1.03-6.4]) as independent predictors of 1-year mortality. Only 17% of patients with pre-extracorporeal membrane oxygenation Sequential Organ Failure Assessment scores of 14 or more survived, whereas 52% of those with scores less than 7 and 60% of those with scores 7 or more and less than 11 were alive 1 year later.
Among this selected cohort of 105 patients implanted with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure, 1-year survival was 42%, but better for patients with pre-extracorporeal membrane oxygenation Sequential Organ Failure Assessment scores of less than 11. Venoarterial-extracorporeal membrane oxygenation should be considered for patients with acute decompensated heart failure, but timing of implantation is crucial.
接受静脉动脉体外膜肺氧合治疗的急性失代偿性心力衰竭（即合并慢性心肌病的心源性休克）患者的长期预后尚未报道。本研究旨在描述其预后，并确定与死亡率相关的因素。
前瞻性收集数据的回顾性分析。
26 床三级医院 ICU。
105 例因急性失代偿性心力衰竭植入静脉动脉体外膜肺氧合的患者。
无。
从 2007 年 3 月至 2015 年 1 月，105 例患者在我们的 ICU 中植入静脉动脉体外膜肺氧合治疗急性失代偿性心力衰竭（其中 67%的患者使用主动脉内球囊泵来减轻左心室负荷）。他们的 1 年生存率为 42%；大多数幸存者直接接受心脏移植，或在切换到中央双侧离心泵、心室辅助装置或全人工心脏后接受移植。大多数死亡发生在多器官衰竭早期。多变量分析保留了（比值比[95%置信区间]）体外膜肺氧合前序贯器官衰竭评估评分>11（3.3[1.3-8.3]）、特发性心肌病（0.4[0.2-1]）、体外膜肺氧合前心脏疾病持续时间>2 年（2.8[1.2-6.9]）和体外膜肺氧合前血乳酸>4mmol/L（2.6[1.03-6.4]）是 1 年死亡率的独立预测因素。仅有 17%的体外膜肺氧合前序贯器官衰竭评估评分≥14 的患者存活，而评分<7 的患者中有 52%存活，评分 7 或更高且<11 的患者中有 60%存活。
在接受静脉动脉体外膜肺氧合治疗的 105 例急性失代偿性心力衰竭患者中，1 年生存率为 42%，但体外膜肺氧合前序贯器官衰竭评估评分<11 的患者生存率更高。对于急性失代偿性心力衰竭患者，应考虑静脉动脉体外膜肺氧合，但植入时机至关重要。
