体外膜肺氧合治疗呼吸衰竭成人的神经损伤：体外生命支持组织数据库的研究结果。

Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure: Findings From the Extracorporeal Life Support Organization Database.

机构信息

1Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.2Cardiology Unit, Cardiology Institute, University of L'Aquila, L'Aquila, Italy.3Cardiac Surgery Unit, S.Croce Hospital, Cuneo, Italy.4Cardiology Unit, Community Hospital, University of Brescia, Brescia, Italy.5Extracorporeal Life Support Organization (ELSO), University of Michigan, Ann Arbor, MI.6ECMO Department, University of Wurzburg, Wurzburg, Germany.7Department of Internal Medicine, University Hospital of Regensburg, Regensburg, Germany.8Department of Anesthesia, Ca' Granda Hospital, Milan, Italy.9Medical Intensive Care Unit, La Pitiè-Salpetriere Hospital, Paris, France.10Department of Cardio-Thoracic Surgery Unit, Montefiore Hospital, New York, NY.11ECMO Unit, Karolinska Hospital, Stockholm, Sweden.12Pediatric Intensive Care Unit, Bambin Gesù Hospital, Rome, Italy.13Intensive Care and Emergency Medicine Department, Helios Frankelwaldklinik, Kronach, Germany.14Cardiac Intensive Care Unit, Boston Children's Hospital, Boston, MA.

出版信息

Crit Care Med. 2017 Aug;45(8):1389-1397. doi: 10.1097/CCM.0000000000002502.

DOI:10.1097/CCM.0000000000002502

PMID:28538440

Abstract

OBJECTIVES

To assess in-hospital neurologic (CNS) complications in adult patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure.

DESIGN

Retrospective analysis of the Extracorporeal Life Support Organization's data registry.

SETTING

Data reported to Extracorporeal Life Support Organization from 350 international extracorporeal membrane oxygenation centers during 1992-2015.

PATIENTS

Adults (≥ 18 yr old) supported with veno-venous extracorporeal membrane oxygenation for respiratory failure.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We included 4,988 adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. Neurologic injury was defined as brain death, seizures, stroke, and intracranial hemorrhage occurring during extracorporeal membrane oxygenation support. We used multivariable logistic regression to explore patient and extracorporeal membrane oxygenation factors associated with neurologic injury. Median age of the study cohort was 46 (interquartile range, 32-58). Four hundred twenty-six neurologic complications were reported in 356 patients (7.1%), and included 181 intracranial hemorrhage (42.5%), 100 brain deaths (23.5%), 85 stroke (19.9%), and 60 seizure events (14.1%). In-hospital mortality was significantly higher for those with CNS complications (75.8% vs 37.8%; p < 0.001) and varied by type of CNS injury; mortality was 79.6% in patients with intracranial hemorrhage, 68.2% in patients with stroke, and 50% in patients with seizures. Pre-extracorporeal membrane oxygenation cardiac arrest, continuous veno-venous hemofiltration, and hyperbilirubinemia during extracorporeal membrane oxygenation were associated with increased odds of neurologic injury.

CONCLUSIONS

Approximately 7% of adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure had neurologic injury. Intracranial hemorrhage was the most frequent type, and survival for patients with neurologic injury was poor. Future investigations should evaluate anticoagulation management as well as brain/extracorporeal membrane oxygenation interaction to reduce these life-threatening events.

摘要

目的

评估成人因呼吸衰竭行静脉-静脉体外膜肺氧合治疗期间的院内神经系统（CNS）并发症。

设计

对体外生命支持组织的数据登记进行回顾性分析。

设置

1992 年至 2015 年期间，350 个国际体外膜肺氧合中心向体外生命支持组织报告的数据。

患者

因呼吸衰竭行静脉-静脉体外膜肺氧合治疗的成人（≥18 岁）。

干预

无。

测量和主要结果

共纳入 4988 例因呼吸衰竭行静脉-静脉体外膜肺氧合治疗的成人。神经系统损伤定义为体外膜肺氧合支持期间发生脑死亡、癫痫发作、中风和颅内出血。我们使用多变量逻辑回归来探讨与神经系统损伤相关的患者和体外膜肺氧合因素。研究队列的中位年龄为 46 岁（四分位距 32-58 岁）。356 例患者中有 426 例（7.1%）发生神经系统并发症，包括 181 例颅内出血（42.5%）、100 例脑死亡（23.5%）、85 例中风（19.9%）和 60 例癫痫发作（14.1%）。有中枢神经系统并发症的患者院内死亡率显著更高（75.8% vs. 37.8%；p <0.001），且与中枢神经系统损伤类型有关；颅内出血患者的死亡率为 79.6%，中风患者为 68.2%，癫痫发作患者为 50%。体外膜肺氧合前心脏骤停、持续静脉-静脉血液滤过和体外膜肺氧合期间高胆红素血症与神经系统损伤的可能性增加相关。