Takauji Shuhei, Hayakawa Mineji, Ono Kota, Makise Hiroshi
Department of Emergency Medicine Asahikawa Medical University Asahikawa Japan.
Department of Emergency Medicine and Critical Care Sapporo City General Hospital Sapporo Japan.
Acute Med Surg. 2017 Jul 17;4(4):408-417. doi: 10.1002/ams2.296. eCollection 2017 Oct.
This multicenter retrospective observational study aimed to evaluate the efficacy of extracorporeal membrane oxygenation (ECMO) support for septic patients with severe respiratory failure using propensity score analyses.
The data of severe sepsis patients from 42 intensive care units between January 2011 and December 2013 were retrospectively collected. Propensity score matching analyses were undertaken for severe respiratory failure patients with/without veno-venous ECMO support. The main outcome was in-hospital all-cause mortality.
Of 3195 patients with severe sepsis, 570 had severe respiratory failure. Forty patients in the ECMO group were matched with 150 patients in the control group. A survival time analysis revealed no difference in the in-hospital survival (hazard ratio, 0.854; 95% confidence interval, 0.531-1.373; = 0.515). Two-hundred and eighty-five patients had severe respiratory failure induced by lung infection. Twenty-five ECMO group patients were matched with 89 patients in the control group. In the ECMO group, the survival time was longer than in the control group (hazard ratio, 0.498; 95% confidence interval, 0.279-0.889; = 0.018). The number of renal replacement therapy- and vasopressor-free days improved. The ECMO group received more red blood cells transfused than the control group, but there was no significant difference in the rate of severe bleeding complications between the groups.
There was no difference in the in-hospital survival between the ECMO group and control group among overall septic patients with severe respiratory failure. However, in sepsis patients with severe respiratory failure induced by lung infection, ECMO support may improve their survival time.
本多中心回顾性观察研究旨在通过倾向评分分析评估体外膜肺氧合（ECMO）对严重呼吸衰竭脓毒症患者的支持疗效。
回顾性收集2011年1月至2013年12月期间来自42个重症监护病房的严重脓毒症患者的数据。对接受/未接受静脉-静脉ECMO支持的严重呼吸衰竭患者进行倾向评分匹配分析。主要结局是院内全因死亡率。
在3195例严重脓毒症患者中，570例有严重呼吸衰竭。ECMO组的40例患者与对照组的150例患者进行了匹配。生存时间分析显示，院内生存率无差异（风险比，0.854；95%置信区间，0.531 - 1.373；P = 0.515）。285例患者因肺部感染导致严重呼吸衰竭。ECMO组的25例患者与对照组的89例患者进行了匹配。在ECMO组中，生存时间长于对照组（风险比，0.498；95%置信区间，0.279 - 0.889；P = 0.018）。无肾替代治疗和无血管升压药的天数有所改善。ECMO组输注的红细胞比对照组多，但两组严重出血并发症发生率无显著差异。
在总体严重呼吸衰竭的脓毒症患者中，ECMO组和对照组的院内生存率无差异。然而，在因肺部感染导致严重呼吸衰竭的脓毒症患者中，ECMO支持可能会改善其生存时间。
