Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
Academy of Humanities and Innovation, Taipei City Hospital, Taipei, Taiwan.
PLoS One. 2018 Apr 6;13(4):e0195445. doi: 10.1371/journal.pone.0195445. eCollection 2018.
The ageing population and the expected increase in the number of elderly patients make an evidence-based assessment of Extracorporeal Membrane Oxygenation (ECMO) therapy in old patients progressively more important. Veno-arterial (VA) ECMO results for patient aged <65 years is well known. However, the risk profile and in-hospital prognosis of advanced age patients with ECMO still need more investigation. The aim of this study was to identify risk factors that predicted the outcomes for elderly patients who received VA-ECMO.
In this retrospective study, medical records for patients with ECMO aged 65 years and over were collected between 2009 and 2012 at a tertiary hospital.
A total of 99 patients (mean age: 76.4±6.4 years) were included. The most common condition requiring VA-ECMO support was cardiogenic shock. Among survivors on VA-ECMO, 28 (28.3%) patients were successfully weaned from support. Thirteen (13.1%) patients were successfully discharged. We found that cardiogenic shock (OR = 3.158, P = 0.013), acute physiology and chronic health evaluation II (APACHE II) score (OR = 1.147, P<0.001), and simplified acute physiology score II (SAPS II) score (OR = 1.054, P = 0.001) were risk factors associated with survival on VA-ECMO. By using the areas under the receiver operating characteristic (AUC) curve, the APACHE II score and SAPS II score displayed acceptable discriminative power (AUC 0.722; 0.715, respectively).
Our findings indicate that the risk of mortality increases with cardiogenic shock, higher APACHE II score, and higher SAPS II score. These risk factors can be utilized as potential predictors to identify the potential candidates for ECMO support.
人口老龄化和老年患者数量预计增加，使得对老年患者体外膜肺氧合（ECMO）治疗进行基于证据的评估变得越来越重要。年龄<65 岁的患者使用静脉-动脉（VA）ECMO 的结果是众所周知的。然而，ECMO 高龄患者的风险状况和院内预后仍需要更多的研究。本研究的目的是确定预测接受 VA-ECMO 的老年患者结局的危险因素。
在这项回顾性研究中，收集了 2009 年至 2012 年在一家三级医院接受 ECMO 的年龄≥65 岁的患者的病历。
共纳入 99 例患者（平均年龄：76.4±6.4 岁）。最常见的需要 VA-ECMO 支持的情况是心源性休克。在接受 VA-ECMO 的存活者中，28 例（28.3%）患者成功脱机。13 例（13.1%）患者成功出院。我们发现心源性休克（OR=3.158，P=0.013）、急性生理学和慢性健康评估 II（APACHE II）评分（OR=1.147，P<0.001）和简化急性生理学评分 II（SAPS II）评分（OR=1.054，P=0.001）是与 VA-ECMO 存活相关的危险因素。通过使用接受者操作特征（ROC）曲线下的面积（AUC），APACHE II 评分和 SAPS II 评分显示出可接受的区分能力（AUC 0.722；0.715）。
我们的研究结果表明，死亡率随着心源性休克、更高的 APACHE II 评分和更高的 SAPS II 评分而增加。这些危险因素可以用作潜在的预测因子，以识别潜在的 ECMO 支持候选者。
