Stoyle George, Fawcett Peter, Malagon Ignacio
Wythenshawe Hospital, Manchester University Foundation Trust, Wythenshawe, Manchester, UK.
The University of Manchester, Manchester, UK.
J Artif Organs. 2018 Sep;21(3):293-299. doi: 10.1007/s10047-018-1026-5. Epub 2018 Feb 20.
The purpose of this study is to determine the effect of illicit drug and alcohol dependencies on mortality, length of stay, and complications in patients who have been supported with veno-venous extracorporeal membrane oxygenation (VV-ECMO) following respiratory failure not responsive to conventional methods of ventilation. 584 VV-ECMO referrals received at Wythenshawe Hospital were reviewed for evidence of drug dependency. 13 patients were identified as being drug-dependent and having undergone treatment with VV-ECMO. A matched cohort of 13 non-drug-dependent patients was identified using date of birth, pre-ECMO Murray Score, and primary diagnosis. The outcomes were compared. 19 more complications were found amongst the drug-dependent patients compared with the non-drug-dependent cohort (39 vs 20). A mean difference of 1.46 complications per patient was calculated (p = 0.005). Mortality after 180 days was reported in 4 of the drug-dependent patients, compared with one in the matched cohort. Length of stay on ECMO was increased on average by 1.93 days amongst the drug-dependent patients (p = 0.557); however, the sample size was not great enough to achieve statistical significance. Patients with drug dependencies undergoing VV-ECMO have more complications when compared with a cohort of patients with no proven or suspected drug dependencies. Differences in morbidity and mortality were not statistically significant.
本研究的目的是确定非法药物和酒精依赖对在呼吸衰竭对传统通气方法无反应后接受静脉-静脉体外膜肺氧合（VV-ECMO）支持的患者的死亡率、住院时间和并发症的影响。对怀滕沙韦医院收到的584例VV-ECMO转诊病例进行了审查，以寻找药物依赖的证据。13例患者被确定为药物依赖并接受了VV-ECMO治疗。使用出生日期、ECMO前默里评分和初步诊断确定了13例非药物依赖患者的匹配队列。对结果进行了比较。与非药物依赖队列相比，药物依赖患者中发现的并发症多19例（39例对20例）。计算出每位患者的并发症平均差异为1.46例（p = 0.005）。报告称，180天后，4例药物依赖患者死亡，而匹配队列中有1例死亡。药物依赖患者的ECMO住院时间平均增加了1.93天（p = 0.557）；然而，样本量不够大，无法达到统计学显著性。与没有已证实或疑似药物依赖的患者队列相比，接受VV-ECMO治疗的药物依赖患者有更多并发症。发病率和死亡率的差异无统计学显著性。
