Division of Cardiac Anesthesiology, Tufts Medical Center, Tufts Medical School, Boston, MA.
Division of Cardiac Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Cardiothorac Vasc Anesth. 2019 May;33(5):1325-1330. doi: 10.1053/j.jvca.2018.09.037. Epub 2018 Sep 27.
At a quaternary care center that regularly performs and cares for patients undergoing extracorporeal membrane oxygenation (ECMO), a database of all adult patients since 2009 was assembled with echocardiographic parameters of left (LV) and right (RV) ventricular function. From the database, 175 venoarterial (VA) and 74 venovenous (VV) ECMO patients were analyzed to compare the decannulation echocardiographic assessments of biventricular function before, during, and after ECMO in survivors and nonsurvivors.
Retrospective chart review-based study.
A single quaternary care center.
All adult patients who received ECMO from 2009 to 2017 with both survival data and echographic studies were included in this retrospective study.
When indicated, transthoracic and transesophageal echocardiograms were performed for ECMO patients. The results of these echocardiograms were reviewed retrospectively, and differences between survivors and nonsurvivors were examined.
A retrospective chart review of before, during cannulation, and after decannulation echocardiographic assessments of biventricular function was performed. On average, VA ECMO survivors had better post-decannulation LV function than did nonsurvivors by a full clinical grade-mild impairment versus moderate impairment (p < 0.001). RV function comparison was similar-mild impairment in survivors versus moderate impairment in nonsurvivors (p = 0.007). LV and RV function before and during ECMO in survivors was not different from that of nonsurvivors. The change in biventricular function from before to after cannulation and during cannulation to post-cannulation was approximately a full clinical grade better in survivors than nonsurvivors (p < 0.01 in all cases). In VV ECMO patients, post-decannulation RV function was significantly worse in nonsurvivors (moderate dysfunction vs borderline normal function) (p = 0.013).
Retrospective chart review of 249 patients suggests that echocardiographic assessment of biventricular function before ECMO cannulation is not prognostic in VA or VV ECMO patients. Post-decannulation assessment of biventricular function may aid in triaging more "at risk" patients because nonsurvivors have significantly worse biventricular function after decannulation. The failure to improve biventricular function from the before to after ECMO phases and the during to after ECMO phases is concerning for a poor prognosis.
在一家经常进行体外膜肺氧合（ECMO）并为接受 ECMO 治疗的患者提供护理的四级保健中心，我们建立了一个包含 2009 年以来所有成人患者超声心动图左心室（LV）和右心室（RV）功能参数的数据库。从该数据库中，我们分析了 175 例静脉动脉（VA）和 74 例静脉-静脉（VV）ECMO 患者，以比较幸存者和非幸存者在 ECMO 前、中、后的双心室功能脱机超声心动图评估。
基于回顾性图表审查的研究。
一家单一的四级保健中心。
所有 2009 年至 2017 年期间接受 ECMO 治疗且具有生存数据和超声影像学研究的成年患者均纳入本回顾性研究。
当有指征时，对 ECMO 患者进行经胸和经食管超声心动图检查。我们回顾性地分析这些超声心动图的结果，并检查幸存者和非幸存者之间的差异。
对双心室功能的脱机前、插管期间和脱机后超声心动图评估进行回顾性图表审查。平均而言，VA ECMO 幸存者的 LV 功能在脱机后比非幸存者更好，表现为完全临床分级的轻度损伤与中度损伤（p<0.001）。RV 功能的比较结果相似，幸存者为轻度损伤，而非幸存者为中度损伤（p=0.007）。幸存者的 LV 和 RV 功能在 ECMO 前和 ECMO 期间与非幸存者没有差异。幸存者从插管前到插管期间再到脱机后的双心室功能变化比非幸存者要好约一个完全临床分级（所有情况均 p<0.01）。在 VV ECMO 患者中，非幸存者的 RV 功能在脱机后明显更差（中度功能障碍与边缘正常功能）（p=0.013）。
对 249 例患者的回顾性图表审查表明，VA 或 VV ECMO 患者在 ECMO 插管前进行双心室功能超声心动图评估与预后无关。脱机后对双心室功能的评估可能有助于对更多“高危”患者进行分诊，因为非幸存者在脱机后双心室功能明显更差。从 ECMO 前到 ECMO 后以及 ECMO 期间到 ECMO 后双心室功能没有改善是预后不良的一个令人担忧的迹象。
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