Munshi Laveena, Kiss Alex, Cypel Marcelo, Keshavjee Shaf, Ferguson Niall D, Fan Eddy
Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada.
Institute for Clinical Evaluative Sciences.
Crit Care Med. 2017 Dec;45(12):1997-2005. doi: 10.1097/CCM.0000000000002643.
Extracorporeal life support can lead to rapid reversal of hypoxemia and shock; however, it can also result in varying degrees of hyperoxia. Recent data have suggested an association between hyperoxia and mortality; however, this conclusion has not been consistent across the literature. We evaluated the association between oxygenation thresholds and mortality in three cohorts of extracorporeal life support patients.
We performed a retrospective cohort study using the Extracorporeal Life Support Organization Registry.
We evaluated the relationship between oxygenation measured 24 hours after extracorporeal membrane oxygenation onset and mortality (2010-2015).
The extracorporeal life support cohorts were as follows: 1) veno-venous extracorporeal membrane oxygenation for respiratory failure, 2) veno-arterial extracorporeal membrane oxygenation for cardiogenic shock, and 3) extracorporeal cardiopulmonary resuscitation.
The relationships between hypoxemia (PaO2 < 60mm Hg), normoxia (PaO2 60-100mm Hg), moderate hyperoxia (PaO2 101-300mm Hg), extreme hyperoxia (PaO2 > 300 mm Hg), and mortality were evaluated across three extracorporeal life support cohorts.
Seven hundred sixty-five patients underwent veno-venous extracorporeal membrane oxygenation, 775 patients underwent veno-arterial extracorporeal membrane oxygenation, and 412 underwent extracorporeal cardiopulmonary resuscitation. During veno-venous extracorporeal membrane oxygenation, hypoxemia (odds ratio, 1.68; 95% CI, 1.09-2.57) and moderate hyperoxia (odds ratio, 1.66; 95% CI, 1.11-2.50) were associated with increased mortality compared with normoxia. There was no association between oxygenation and mortality for veno-arterial extracorporeal membrane oxygenation. Moderate hyperoxia was associated with increased mortality during extracorporeal cardiopulmonary resuscitation compared with normoxia (odds ratio, 1.77; 95% CI, 1.03-3.30). An exploratory analysis did not find more specific PaO2 thresholds associated with mortality within moderate hyperoxia.
Moderate hyperoxia was associated with increased mortality in patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure and extracorporeal cardiopulmonary resuscitation. Hypoxemia was associated with an increased mortality in veno-venous extracorporeal membrane oxygenation. No association was seen between oxygenation and mortality in veno-arterial extracorporeal membrane oxygenation which may be due to early death driven by the underlying disease.
体外生命支持可导致低氧血症和休克迅速逆转；然而，它也可能导致不同程度的高氧血症。近期数据表明高氧血症与死亡率之间存在关联；然而，这一结论在文献中并不一致。我们评估了三组体外生命支持患者的氧合阈值与死亡率之间的关联。
我们使用体外生命支持组织登记处进行了一项回顾性队列研究。
我们评估了体外膜肺氧合开始后24小时测得的氧合与死亡率（2010 - 2015年）之间的关系。
体外生命支持队列如下：1）用于呼吸衰竭的静脉 - 静脉体外膜肺氧合，2）用于心源性休克的静脉 - 动脉体外膜肺氧合，3）体外心肺复苏。
在三组体外生命支持队列中评估了低氧血症（动脉血氧分压<60mmHg）、正常氧合（动脉血氧分压60 - 100mmHg）、中度高氧血症（动脉血氧分压101 - 300mmHg）、极度高氧血症（动脉血氧分压>300mmHg）与死亡率之间的关系。
765例患者接受了静脉 - 静脉体外膜肺氧合，775例患者接受了静脉 - 动脉体外膜肺氧合，412例患者接受了体外心肺复苏。在静脉 - 静脉体外膜肺氧合期间，与正常氧合相比，低氧血症（比值比，1.68；95%置信区间，1.09 - 2.57）和中度高氧血症（比值比，1.66；95%置信区间，1.11 - 2.50）与死亡率增加相关。静脉 - 动脉体外膜肺氧合的氧合与死亡率之间无关联。与正常氧合相比，体外心肺复苏期间中度高氧血症与死亡率增加相关（比值比，1.77；95%置信区间，1.03 - 3.30）。一项探索性分析未发现中度高氧血症范围内与死亡率相关的更具体的动脉血氧分压阈值。
对于因呼吸衰竭接受静脉 - 静脉体外膜肺氧合和体外心肺复苏的患者，中度高氧血症与死亡率增加相关。低氧血症与静脉 - 静脉体外膜肺氧合时死亡率增加相关。静脉 - 动脉体外膜肺氧合的氧合与死亡率之间未发现关联，这可能是由于基础疾病导致的早期死亡。
