Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland; Department of Surgery, University of Oulu, Oulu, Finland.
Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
J Thorac Cardiovasc Surg. 2020 May;159(5):1844-1854.e6. doi: 10.1016/j.jtcvs.2019.06.039. Epub 2019 Jul 2.
The aim of this study was to identify the risk factors associated with early mortality after postcardiotomy venoarterial extracorporeal membrane oxygenation.
This is an analysis of the postcardiotomy extracorporeal membrane oxygenation registry, a retrospective multicenter cohort study including 781 patients aged more than 18 years who required venoarterial extracorporeal membrane oxygenation for cardiopulmonary failure after cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers.
After a mean venoarterial extracorporeal membrane oxygenation therapy of 6.9 ± 6.2 days, hospital and 1-year mortality were 64.4% and 67.2%, respectively. Hospital mortality after venoarterial extracorporeal membrane oxygenation therapy for more than 7 days was 60.5% (P = .105). Centers that had treated more than 50 patients with postcardiotomy venoarterial extracorporeal membrane oxygenation had a significantly lower hospital mortality than lower-volume centers (60.7% vs 70.7%, adjusted odds ratio, 0.58; 95% confidence interval, 0.41-0.82). The postcardiotomy extracorporeal membrane oxygenation score was derived by assigning a weighted integer to each independent pre-venoarterial extracorporeal membrane oxygenation predictors of hospital mortality as follows: female gender (1 point), advanced age (60-69 years, 2 points; ≥70 years, 4 points), prior cardiac surgery (1 point), arterial lactate 6.0 mmol/L or greater before venoarterial extracorporeal membrane oxygenation (2 points), aortic arch surgery (4 points), and preoperative stroke/unconsciousness (5 points). The hospital mortality rates according to the postcardiotomy extracorporeal membrane oxygenation score was 0 point, 45.6%; 1 point, 40.5%; 2 points, 51.1%; 3 points, 57.8%; 4 points, 70.7%; 5 points, 68.3%; 6 points, 77.5%; and 7 points or more, 89.7% (P < .0001).
Age, female gender, prior cardiac surgery, preoperative acute neurologic events, aortic arch surgery, and increased arterial lactate were associated with increased risk of early mortality after postcardiotomy venoarterial extracorporeal membrane oxygenation. Center experience with postcardiotomy venoarterial extracorporeal membrane oxygenation may contribute to improved results.
本研究旨在确定体外膜肺氧合术后早期死亡率相关的危险因素。
这是一项对心脏手术后体外膜肺氧合登记处的分析，回顾性多中心队列研究纳入了 2010 年至 2018 年 19 家心脏外科中心 18 岁以上因心肺衰竭需要静脉动脉体外膜肺氧合治疗的 781 例患者。
在平均 6.9±6.2 天的静脉动脉体外膜肺氧合治疗后，住院死亡率和 1 年死亡率分别为 64.4%和 67.2%。静脉动脉体外膜肺氧合治疗超过 7 天的住院死亡率为 60.5%（P=0.105）。接受体外膜肺氧合治疗的患者超过 50 例的中心的住院死亡率明显低于低容量中心（60.7%比 70.7%，调整后的优势比，0.58；95%置信区间，0.41-0.82）。体外膜肺氧合评分是通过为每个独立的静脉动脉体外膜肺氧合前预测住院死亡率的因素分配加权整数来计算的，如下：女性（1 分）、高龄（60-69 岁，2 分；≥70 岁，4 分）、既往心脏手术史（1 分）、静脉动脉体外膜肺氧合前动脉血乳酸 6.0mmol/L 或更高（2 分）、主动脉弓手术（4 分）和术前卒中/意识障碍（5 分）。根据体外膜肺氧合评分，住院死亡率为 0 分，45.6%；1 分，40.5%；2 分，51.1%；3 分，57.8%；4 分，70.7%；5 分，68.3%；6 分，77.5%；7 分或更多，89.7%（P<0.0001）。
年龄、女性、既往心脏手术史、术前急性神经事件、主动脉弓手术和动脉血乳酸升高与心脏手术后静脉动脉体外膜肺氧合早期死亡率增加相关。体外膜肺氧合治疗的中心经验可能有助于改善结果。
