El Sibai Rayan, Bachir Rana, El Sayed Mazen
Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box - 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon.
BMC Emerg Med. 2018 Jul 4;18(1):20. doi: 10.1186/s12873-018-0171-8.
Extracorporeal membrane oxygenation (ECMO) is increasingly used in resuscitation of critically ill patients with documented improved survival. Few studies describe ECMO use in cardiogenic shock. This study examines ECMO use and identifies variables associated with mortality in patients treated for cardiogenic shock in US hospitals.
A retrospective observational study of the US Nationwide Emergency Department Sample (NEDS) database of 2013 was conducted. Weighted visits for cardiogenic shock (discharge diagnosis) with ECMO use were included. Collected data was analyzed and variables associated with mortality were identified.
A total of 922 weighted patients with cardiogenic shock and ECMO were included. Mean age was 50.8 years. They were more commonly males (66.3%; n = 658). Slightly over half (51.0%, n = 506) survived to hospital discharge. Mean charges per patient were $589,610.5. Mean length of stay was 21.8 days. Increased mortality was associated with presence of respiratory diseases (OR = 3.83), genitourinary diseases (OR = 4.97), undergoing an echocardiogram (OR = 4.63), and presenting during seasons other than Fall. Lower mortality was noted in patients with injury and poisoning (OR = 0.47), in those who underwent certain vascular procedures (OR = 0.49) and those with increasing length of stay (OR = 0.90).
Mortality in patients with cardiogenic shock remains high despite ECMO use. Season of admission (other than Fall) and presence of specific comorbidities (Respiratory and genitourinary diseases) are associated with increased mortality in this population. Familiarity with these variables can help identify patients at higher risk of death and can help improve outcomes further in cardiogenic shock.
体外膜肺氧合（ECMO）越来越多地用于危重症患者的复苏，且已证明其可提高生存率。很少有研究描述ECMO在心源性休克中的应用。本研究调查了美国医院中接受心源性休克治疗的患者使用ECMO的情况，并确定与死亡率相关的变量。
对2013年美国全国急诊科样本（NEDS）数据库进行回顾性观察研究。纳入使用ECMO的心源性休克（出院诊断）加权就诊病例。对收集的数据进行分析，并确定与死亡率相关的变量。
共纳入922例使用ECMO的心源性休克加权患者。平均年龄为50.8岁。男性更为常见（66.3%；n = 658）。略超过一半（51.0%，n = 506）的患者存活至出院。每位患者的平均费用为589,610.5美元。平均住院时间为21.8天。死亡率增加与呼吸系统疾病（OR = 3.83）、泌尿生殖系统疾病（OR = 4.97）、接受超声心动图检查（OR = 4.63）以及在秋季以外的季节就诊有关。创伤和中毒患者（OR = 0.47）、接受某些血管手术的患者（OR = 0.49）以及住院时间延长的患者（OR = 0.90）的死亡率较低。
尽管使用了ECMO，但心源性休克患者的死亡率仍然很高。入院季节（秋季以外）和特定合并症（呼吸系统和泌尿生殖系统疾病）的存在与该人群死亡率增加有关。熟悉这些变量有助于识别死亡风险较高的患者，并有助于进一步改善心源性休克的治疗结果。
