急性呼吸衰竭静脉-静脉体外膜肺氧合多学科团队组建的学习曲线

Learning curve for multidisciplinary team setup in veno-venous extracorporeal membrane oxygenation for acute respiratory failure.

作者信息

Yeo Hye Ju, Cho Woo Hyun, Kim Dohyung

机构信息

1 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.

2 Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.

出版信息

Perfusion. 2019 Apr;34(1_suppl):30-38. doi: 10.1177/0267659119827424.

DOI:10.1177/0267659119827424

PMID:30966902

Abstract

BACKGROUND

Quality control is essential for a successful extracorporeal membrane oxygenation program. We investigated the learning curve for outcome improvement and focused on factors associated with failure of extracorporeal membrane oxygenation treatment.

METHODS

Between August 2011 and May 2017, 150 patients were supported with veno-venous extracorporeal membrane oxygenation for acute respiratory failure. The learning curve was examined using cumulative sum analysis. We defined successful extracorporeal membrane oxygenation treatment as intensive care unit discharge, acceptable failure rate as 40%, and unacceptable failure rate as 60%. We chronologically divided patients into three periods with 50 consecutive patients each and retrospectively compared the clinical outcomes by period.

RESULTS

Overall, weaning and survival to discharge rates were 72.7% and 56%, respectively. Cumulative sum analysis indicated that the extracorporeal membrane oxygenation team achieved nearly acceptable performance after 56 cases and consistently acceptable performance after 104 cases. Clinical outcomes were improved by period: weaning rate (58% vs. 80% vs. 80%, p = 0.017); intensive care unit discharge rate (42% vs. 60% vs. 78%, p = 0.001); survival to discharge rate (40% vs. 58% vs. 70%, p = 0.010); and 1 year survival rate (40% vs. 56% vs. 70%, p = 0.010). In multivariate analysis, infection (odds ratio: 4.54, 95% confidence interval: 1.83-11.27, p = 0.001), immune compromise (odds ratio: 5.78, 95% confidence interval: 1.66-20.14, p = 0.006), extracorporeal membrane oxygenation team period (odds ratio: 2.12, 95% confidence interval: 1.14-3.92, p = 0.017), and age (odds ratio: 1.09, 95% confidence interval: 1.05-1.14, p < 0.001) were associated with extracorporeal membrane oxygenation failure.

CONCLUSION

More than 100 cases of extracorporeal membrane oxygenation experience were necessary for acceptable performance and stabilization of outcomes.

摘要

背景

质量控制对于成功开展体外膜肺氧合（ECMO）项目至关重要。我们研究了改善预后的学习曲线，并关注与体外膜肺氧合治疗失败相关的因素。

方法

2011年8月至2017年5月期间，150例急性呼吸衰竭患者接受了静脉-静脉体外膜肺氧合支持。使用累积和分析来检查学习曲线。我们将成功的体外膜肺氧合治疗定义为重症监护病房出院，可接受的失败率为40%，不可接受的失败率为60%。我们按时间顺序将患者分为三个时期，每个时期连续50例患者，并回顾性比较各时期的临床结局。

结果

总体而言，脱机率和出院生存率分别为72.7%和56%。累积和分析表明，体外膜肺氧合团队在56例病例后达到了近乎可接受的表现，在104例病例后持续保持可接受的表现。各时期的临床结局有所改善：脱机率（58%对80%对80%，p = 0.017）；重症监护病房出院率（42%对60%对78%，p = 0.001）；出院生存率（40%对58%对70%，p = 0.010）；以及1年生存率（40%对56%对70%，p = 0.010）。在多变量分析中，感染（比值比：4.54，95%置信区间：1.83 - 11.27，p = 0.001）、免疫功能低下（比值比：5.78，95%置信区间：1.66 - 20.14，p = 0.006）、体外膜肺氧合团队时期（比值比：2.12，95%置信区间：1.14 - 3.92，p = 0.017）和年龄（比值比：1.09，95%置信区间：1.05 - 1.14，p < 0.001）与体外膜肺氧合失败相关。