Service de Réanimation médicale, DHU A-TVB, Hôpital Henri Mondor, AP-HP, Créteil, France.
Service de Réanimation médicale, CHU de Poitiers, Poitiers, France.
Crit Care Med. 2019 Mar;47(3):e263-e265. doi: 10.1097/CCM.0000000000003628.
Extracorporeal life support could be helpful for severe acute chest syndrome in adults sickle cell disease, because of the frequent hemodynamic compromise in this setting, including acute pulmonary vascular dysfunction and right ventricular failure. The aim of this study was to report the extracorporeal life support experience for severe acute chest syndrome in four referral centers in France.
The primary endpoint of this multicentric retrospective study was ICU survival of patients with severe acute chest syndrome managed with extracorporeal life support. Secondary endpoints included comparisons between survivors and nonsurvivors.
We performed this study between January 2009 and July 2017 in four referral centers in France.
We included adult patients (age > 18 yr) with sickle cell disease, admitted for severe acute chest syndrome and who required extracorporeal life support during the ICU stay.
The study was observational.
Over the 8-year period, 22 patients with sickle cell disease required extracorporeal life support for severe acute chest syndrome, including 10 (45%) veno-venous and 12 (55%) veno-arterial extracorporeal life support. In-ICU mortality was high (73%). Nonsurvivors had a higher severity at extracorporeal life support implantation, as assessed by their Vasoactive-Inotrope Score and number of organ failures.
Our study shows that outcome is impaired in sickle cell disease patients receiving extracorporeal life support while in severe multiple organ failure. Further studies are needed to evaluate selection criteria in this setting.
体外生命支持可能对镰状细胞病成人严重急性胸部综合征有帮助，因为这种情况下经常出现血流动力学障碍，包括急性肺血管功能障碍和右心衰竭。本研究的目的是报告法国四个转诊中心对严重急性胸部综合征进行体外生命支持的经验。
这项多中心回顾性研究的主要终点是接受体外生命支持治疗的严重急性胸部综合征患者的 ICU 生存率。次要终点包括对幸存者和非幸存者的比较。
我们在法国的四个转诊中心进行了这项研究，时间为 2009 年 1 月至 2017 年 7 月。
我们纳入了患有镰状细胞病的成年患者（年龄>18 岁），因严重急性胸部综合征入院，在 ICU 住院期间需要体外生命支持。
研究为观察性。
在 8 年期间，22 例镰状细胞病患者因严重急性胸部综合征需要体外生命支持，包括 10 例（45%）静脉-静脉和 12 例（55%）静脉-动脉体外生命支持。院内死亡率很高（73%）。非幸存者在体外生命支持植入时的严重程度更高，这可通过血管活性药物和器官衰竭的评分来评估。
我们的研究表明，在严重多器官衰竭的情况下，镰状细胞病患者接受体外生命支持的预后较差。需要进一步研究来评估这种情况下的选择标准。
