Elabbassi Wael, Aila Farah Al, Chowdhury Mohammed Andaleeb, Najib Ahmed, Zaid H, Michelin M, Nooryani Arif Al
Department of Cardiovascular Medicine, Al Qassimi Hospital, Sharjah, United Arab Emirates.
Department of Cardiovascular Medicine, Al Qassimi Hospital, Sharjah, United Arab Emirates.
Indian Heart J. 2017 Nov-Dec;69(6):762-766. doi: 10.1016/j.ihj.2017.05.003. Epub 2017 May 12.
ECMO provides respiratory and circulatory support in critically ill patients. In our study, we report on a single center experience with ECMO and aim to identify the prognostic markers for survival to discharge from hospital.
A registry was maintained on all patients who underwent ECMO implantation from September 2012 till January 2016 at a single institution. The collected data was analyzed to identify baseline characteristics, outcomes including clinical variables predictive of poor outcome.
A total of 29 patients underwent ECMO implantation. The average age of patients was 42±18years. 59% were males (N=17). 19 cases had a cardiac indication for ECMO (66%) while 10 cases had a pulmonary indication (34%). On univariate analysis; presence of Multi-organ failure, SOFA score more than 18 and hemoglobin less than 10g/dl at baseline and after ECMO removal were associated with increased 30day mortality. Pearson correlation with 30day mortality showed a positive correlation with MOF (+0.562, p=0.002) and SOFA score >18 (+0.448, p=0.015) and a negative correlation with anemia (-0.507, p=0.005). 15 out of the total 29 patients (52%) died within 30days of admission. Patients with MOF (log rank: 10.926, p=0.001), SOFA score >18 (log rank: 7.758, p=0.005) and hemoglobin <10g/dl (log rank: 5.595, p=0.018) had decreased survival on 30day follow up.
Although the use of ECMO as a last line in the treatment of critical patients refractory to conventional treatment measures constitutes an important improvement in their care; with 48% overall survival; patient selection and timing of ECMO initiation remains challenging. Patients who already had signs of MOF and a high SOFA score portended a poor response. Similarly for anemic patients. Hence the importance of consideration for ECMO use earlier in course of illness rather than later. Screening and aggressive treatment of anemia in those patients may help improve the outcomes.
体外膜肺氧合（ECMO）为重症患者提供呼吸和循环支持。在我们的研究中，我们报告了一家单一中心关于ECMO的经验，并旨在确定出院生存的预后标志物。
对2012年9月至2016年1月在一家单一机构接受ECMO植入的所有患者进行登记。对收集的数据进行分析，以确定基线特征、包括预测不良结局的临床变量在内的结局。
共有29例患者接受了ECMO植入。患者的平均年龄为42±18岁。59%为男性（n = 17）。19例因心脏原因接受ECMO治疗（66%），而10例因肺部原因接受治疗（34%）。单因素分析显示，多器官功能衰竭的存在、基线时和撤除ECMO后序贯器官衰竭评估（SOFA）评分超过18分以及血红蛋白低于10g/dl与30天死亡率增加相关。与30天死亡率的Pearson相关性显示，与多器官功能衰竭呈正相关（+0.562，p = 0.002），与SOFA评分>18呈正相关（+0.448，p = 0.015），与贫血呈负相关（-0.507，p = 0.005）。29例患者中有15例（52%）在入院后30天内死亡。多器官功能衰竭患者（对数秩检验：10.926，p = 0.001）、SOFA评分>18分患者（对数秩检验：7.758，p = 0.005）和血红蛋白<10g/dl患者（对数秩检验：5.595，p = 0.018）在30天随访中的生存率降低。
尽管将ECMO作为对传统治疗措施难治的重症患者的最后一线治疗方法，在其治疗中构成了一项重要进展；总体生存率为48%；患者选择和启动ECMO的时机仍然具有挑战性。已经有多器官功能衰竭迹象和高SOFA评分的患者预后不佳。贫血患者情况类似。因此，在疾病过程中尽早而非晚些时候考虑使用ECMO很重要。对这些患者进行贫血筛查和积极治疗可能有助于改善结局。
