Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, 1-1-6, Tsukumodai, Suita-city, Osaka 565-0862, Japan.
Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, 1-1-6, Tsukumodai, Suita-city, Osaka 565-0862, Japan.
Am J Emerg Med. 2018 Jun;36(6):1003-1008. doi: 10.1016/j.ajem.2017.11.016. Epub 2017 Nov 8.
In out-of-hospital cardiac arrest (OHCA) patients resuscitated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), known as extracorporeal cardiopulmonary resuscitation (ECPR), bleeding is a common complication. The purpose of this study was to assess the risk factors for bleeding complications in ECPR patients.
We retrospectively analyzed the data for OHCA patients admitted to our hospital and resuscitated with ECPR between October 2009 and December 2016. We compared patients with and without major bleeding (i.e. the Bleeding Academic Research Consortium class≥3 bleeding) within 24h of hospital admission. Patients, whose bleeding complication was not evaluated, were excluded.
During the study period, 133 OHCA patients were resuscitated with ECPR, of whom 102 (77%) were included. In total, 71 (70%) patients experienced major bleeding. There were significant differences in age (median 65 vs. 50years, P<0.001), prior antiplatelet therapy (25% vs. 3%, P=0.008), hemoglobin (median 11.6 vs. 12.6g/dL, P=0.003), platelet count (median 125 vs. 155×10/μL, P=0.001), and D-dimer levels on admission (median 18.8 vs. 6.7μg/mL, P<0.001) among patients with and those without major bleeding. Multivariate analysis showed significant associations between major bleeding and D-dimer levels (odds ratio, 1.066; 95% confidence interval, 1.018-1.116). Area under receiver-operating characteristic curve, which describes the accuracy of D-dimer levels in predicting major bleeding, was 0.76 (95% confidence interval, 0.66-0.87).
D-dimer levels may predict major bleeding in ECPR patients, suggesting that hyperfibrinolysis may be related to bleeding.
在接受静脉-动脉体外膜肺氧合（VA-ECMO）复苏的院外心脏骤停（OHCA）患者中，即体外心肺复苏（ECPR），出血是一种常见的并发症。本研究旨在评估 ECPR 患者出血并发症的危险因素。
我们回顾性分析了 2009 年 10 月至 2016 年 12 月期间我院收治并接受 ECPR 复苏的 OHCA 患者的数据。我们比较了入院 24 小时内有和无大出血（即 Bleeding Academic Research Consortium 分级≥3 级出血）的患者。未评估出血并发症的患者被排除在外。
在研究期间，共有 133 例 OHCA 患者接受 ECPR 复苏，其中 102 例（77%）被纳入研究。共有 71 例（70%）患者发生大出血。有大出血的患者与无大出血的患者在年龄（中位数 65 岁 vs. 50 岁，P<0.001）、既往抗血小板治疗（25% vs. 3%，P=0.008）、血红蛋白（中位数 11.6 克/分升 vs. 12.6 克/分升，P=0.003）、血小板计数（中位数 125×10/微升 vs. 155×10/微升，P=0.001）和入院时 D-二聚体水平（中位数 18.8 微克/毫升 vs. 6.7 微克/毫升，P<0.001）方面存在显著差异。多变量分析显示，大出血与 D-二聚体水平之间存在显著相关性（比值比，1.066；95%置信区间，1.018-1.116）。描述 D-二聚体水平预测大出血准确性的受试者工作特征曲线下面积为 0.76（95%置信区间，0.66-0.87）。
D-二聚体水平可能预测 ECPR 患者的大出血，提示高纤溶可能与出血有关。
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