Freundt Miriam, Lunz Dirk, Philipp Alois, Panholzer Bernd, Lubnow Matthias, Friedrich Christine, Rupprecht Leopold, Hirt Stephan, Haneya Assad
Dept. of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany.
Dept. of Anesthesiology and Critical Care, University Medical Center of Regensburg, Regensburg, Germany.
PLoS One. 2017 Oct 19;12(10):e0184995. doi: 10.1371/journal.pone.0184995. eCollection 2017.
Veno-arterial extracorporeal life support (ECLS) is an established method to stabilize acute circulatory failure. Parameters and data on when to ideally wean circulatory support are limited. Bilirubin is a marker of end-organ damage. Therefore, the purpose of this large study was to evaluate the impact of dynamic changes of elevated bilirubin levels on survival in patients on ECLS.
We reviewed 502 consecutive cases of ECLS from 2007 to 2015. Bilirubin levels were recorded before implantation and until six days after explantation. Dynamic bilirubin changes, and hemodynamic and laboratory outcome parameters were compared in survivors and nonsurvivors. Reason for ECLS implantation was cardiac arrest with ongoing resuscitation in 230 (45.8%), low cardiac output in 174 (34.7%) and inability to wean off cardiopulmonary bypass in 98 (19.5%) patients. 307 (61.2%) patients were weaned off ECLS, however, 206 (41.0%) survived. Mean duration of ECLS was 3 (2-6) days, and survivors received significantly longer ECLS (5 vs 3 days, p < 0.001). Survivors had significantly lower baseline bilirubin levels (p = 0.003). Bilirubin started to rise from day 2 in all patients. In survivors, bilirubin levels had trended down on the day of ECLS explantation and stayed at an acceptable level. However, in weaned patients who did not survive and patients who died on ECLS bilirubin levels continued to rise during the recorded period.
ECLS support improves survival in patients with acute circulatory failure. Down trending bilirubin levels on veno-arterial ECLS indicate improved chances of successful weaning and survival in hemodynamically stable patients.
静脉-动脉体外膜肺氧合（ECLS）是稳定急性循环衰竭的一种既定方法。关于何时理想地撤掉循环支持的参数和数据有限。胆红素是终末器官损伤的一个标志物。因此，这项大型研究的目的是评估胆红素水平升高的动态变化对接受ECLS治疗患者生存的影响。
我们回顾了2007年至2015年连续的502例ECLS病例。记录植入前及撤机后6天内的胆红素水平。比较了幸存者和非幸存者的胆红素动态变化、血流动力学及实验室结果参数。ECLS植入的原因是心脏骤停且正在进行复苏的有230例（45.8%），低心输出量的有174例（34.7%），无法脱离体外循环的有98例（19.5%）。307例（61.2%）患者撤掉了ECLS，然而，206例（41.0%）存活。ECLS的平均持续时间为3（2 - 6）天，幸存者接受ECLS的时间明显更长（5天对3天，p < 0.001）。幸存者的基线胆红素水平明显更低（p = 0.003）。所有患者的胆红素从第2天开始升高。在幸存者中，ECLS撤机当天胆红素水平呈下降趋势并维持在可接受水平。然而，在撤机但未存活的患者以及在ECLS期间死亡的患者中，胆红素水平在记录期内持续升高。
ECLS支持可提高急性循环衰竭患者的生存率。静脉-动脉ECLS时胆红素水平呈下降趋势表明血流动力学稳定的患者成功撤机和存活的机会增加。
