接受长时间体外膜肺氧合呼吸支持的患者的临床转归。
Clinical outcomes of patients receiving prolonged extracorporeal membrane oxygenation for respiratory support.
机构信息
Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul, Republic of Korea.
出版信息
Ther Adv Respir Dis. 2019 Jan-Dec;13:1753466619848941. doi: 10.1177/1753466619848941.
BACKGROUND
There are limited data regarding prolonged extracorporeal membrane oxygenation (ECMO) support, despite increase in ECMO use and duration in patients with respiratory failure. The objective of this study was to investigate the outcomes of severe acute respiratory failure patients supported with prolonged ECMO for more than 28 days.
METHODS
Between January 2012 and December 2015, all consecutive adult patients with severe acute respiratory failure who underwent ECMO for respiratory support at 16 tertiary or university-affiliated hospitals in South Korea were enrolled retrospectively. The patients were divided into two groups: short-term group defined as ECMO for ⩽28 days and long-term group defined as ECMO for more than 28 days. In-hospital and 6-month mortalities were compared between the two groups.
RESULTS
A total of 487 patients received ECMO support for acute respiratory failure during the study period, and the median support duration was 8 days (4-20 days). Of these patients, 411 (84.4%) received ECMO support for ⩽28 days (short-term group), and 76 (15.6%) received support for more than 28 days (long-term group). The proportion of acute exacerbation of interstitial lung disease as a cause of respiratory failure was higher in the long-term group than in the short-term group (22.4% versus 7.5%, p < 0.001), and the duration of mechanical ventilation before ECMO was longer (4 days versus 1 day, p < 0.001). The hospital mortality rate (60.8% versus 69.7%, p = 0.141) and the 6-month mortality rate (66.2% versus 74.0%, p = 0.196) were not different between the two groups. ECMO support longer than 28 days was not associated with hospital mortality in univariable and multivariable analyses.
CONCLUSIONS
Short- and long-term survival rates among patients receiving ECMO support for more than 28 days for severe acute respiratory failure were not worse than those among patients receiving ECMO for 28 days or less.
背景
尽管体外膜肺氧合（ECMO）在呼吸衰竭患者中的使用和持续时间有所增加，但关于 ECMO 支持时间延长的相关数据仍十分有限。本研究旨在调查接受 ECMO 支持超过 28 天的严重急性呼吸衰竭患者的结局。
方法
本回顾性队列研究于 2012 年 1 月至 2015 年 12 月期间，纳入韩国 16 家三级或大学附属医院中因呼吸支持而接受 ECMO 的所有连续成年急性呼吸衰竭患者。患者被分为两组：短期组定义为 ECMO 支持 ⩽28 天，长期组定义为 ECMO 支持超过 28 天。比较两组患者的住院死亡率和 6 个月死亡率。
结果
在研究期间，共有 487 例患者因急性呼吸衰竭接受 ECMO 支持，中位支持时间为 8 天（4-20 天）。其中 411 例（84.4%）患者接受 ECMO 支持 ⩽28 天（短期组），76 例（15.6%）患者接受 ECMO 支持超过 28 天（长期组）。与短期组相比，长期组中急性加重型间质性肺病导致呼吸衰竭的比例更高（22.4%比 7.5%，p<0.001），ECMO 前机械通气时间更长（4 天比 1 天，p<0.001）。两组患者的住院死亡率（60.8%比 69.7%，p=0.141）和 6 个月死亡率（66.2%比 74.0%，p=0.196）均无差异。单因素和多因素分析均显示，ECMO 支持时间超过 28 天与住院死亡率无关。
结论
对于接受 ECMO 支持超过 28 天的严重急性呼吸衰竭患者，短期和长期生存率并不比接受 ECMO 支持 28 天或更短时间的患者差。
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