Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Perioperative Medicine and Intensive Care, Section Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
J Thorac Cardiovasc Surg. 2018 Nov;156(5):1894-1902.e3. doi: 10.1016/j.jtcvs.2018.05.061. Epub 2018 Jun 4.
Refractory postcardiotomy cardiogenic shock is associated with a high mortality, and venoarterial extracorporeal membrane oxygenation can offer acute cardiopulmonary life support. The aim of this study was to identify pre-venoarterial extracorporeal membrane oxygenation risk factors of 90-day mortality.
We retrospectively analyzed 105 consecutive patients supported with venoarterial extracorporeal membrane oxygenation due to refractory postcardiotomy cardiogenic shock. The association between preimplant variables and all-cause mortality at 90 days was analyzed with univariable and multivariable logistic regression.
Main surgical subgroups were single noncoronary artery bypass grafting (29%), isolated coronary artery bypass grafting (20%), and 2 and 3 concomitant surgical procedures (31% and 20%, respectively). The median age of patients was 62 years (interquartile range, 52-68 years), and 76% were men. Cardiopulmonary resuscitation was performed in 30% of patients before venoarterial extracorporeal membrane oxygenation initiation. The median duration of venoarterial extracorporeal membrane oxygenation was 7 days (interquartile range, 3-14). The 90-day overall mortality was 57%, and in-hospital mortality was 56%. Forty-seven percent of patients died on venoarterial extracorporeal membrane oxygenation, 51% of patients were successfully weaned, 1% of patients were bridged to heart transplantation, and 1% of patients were bridged to left ventricular assist device. Multivariable logistic regression analysis identified arterial lactate (odds ratio per unit, 1.22; 95% confidence interval, 1.07-14.0; P = .004) and ischemic heart disease (odds ratio, 7.87; 95% confidence interval, 2.55-24.3; P < .001) as independent risk factors of 90-day mortality.
In patients with postcardiotomy cardiogenic shock, ischemic heart disease and level of arterial lactate before venoarterial extracorporeal membrane oxygenation initiation were identified as independent pre-venoarterial extracorporeal membrane oxygenation risk factors of 90-day mortality. These risk factors are easily available for pre-venoarterial extracorporeal membrane oxygenation risk prediction and may improve patient selection for this resource-intensive therapy.
难治性心脏手术后心源性休克与高死亡率相关，静脉-动脉体外膜肺氧合可提供急性心肺生命支持。本研究旨在确定静脉-动脉体外膜肺氧合前的 90 天死亡率的危险因素。
我们回顾性分析了 105 例因难治性心脏手术后心源性休克而接受静脉-动脉体外膜肺氧合支持的连续患者。使用单变量和多变量逻辑回归分析了植入前变量与 90 天全因死亡率之间的关系。
主要手术亚组为单纯非冠状动脉旁路移植术（29%）、单纯冠状动脉旁路移植术（20%）以及 2 个和 3 个同时进行的手术（分别为 31%和 20%）。患者的中位年龄为 62 岁（四分位距，52-68 岁），76%为男性。在开始静脉-动脉体外膜肺氧合前，30%的患者接受了心肺复苏。静脉-动脉体外膜肺氧合的中位持续时间为 7 天（四分位距，3-14 天）。90 天总死亡率为 57%，院内死亡率为 56%。47%的患者在静脉-动脉体外膜肺氧合期间死亡，51%的患者成功撤机，1%的患者桥接心脏移植，1%的患者桥接左心室辅助装置。多变量逻辑回归分析确定动脉乳酸（单位比值比，1.22；95%置信区间，1.07-14.0；P=.004）和缺血性心脏病（比值比，7.87；95%置信区间，2.55-24.3；P<.001）是静脉-动脉体外膜肺氧合前 90 天死亡率的独立危险因素。
在心脏手术后心源性休克患者中，静脉-动脉体外膜肺氧合前缺血性心脏病和动脉乳酸水平被确定为 90 天死亡率的独立静脉-动脉体外膜肺氧合前危险因素。这些危险因素易于用于静脉-动脉体外膜肺氧合前风险预测，并可能改善对此种资源密集型治疗的患者选择。
