Gulkarov Iosif, Bobka Thomas, Elmously Adham, Salemi Arash, Worku Berhane, Gambardella Ivancarmine, D'Ayala Marcus
Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY; Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, NY.
Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
Ann Vasc Surg. 2020 Jan;62:318-325. doi: 10.1016/j.avsg.2019.06.012. Epub 2019 Aug 23.
Extracorporeal membrane oxygenation (ECMO) is a life-saving modality increasingly used in the management cardiopulmonary failure. However, ECMO itself is not without major complications. Mortality remains high, and morbidity such as stroke, renal failure, and acute limb threatening ischemia (ALI) are common among surviving patients. We analyzed the effect of one of these complications, ALI, on the survival of patients receiving venoarterial ECMO (VA ECMO) with femoral cannulation.
Patients with cardiopulmonary failure supported by VA ECMO inserted through femoral cannulation at two institutions from December 2010 to December 2017 were enrolled in this study. Data were collected retrospectively. Our primary outcome was ALI and its effect on hospital mortality. Secondary outcomes included six-month mortality, length of hospital stay, and other complications (stroke and renal failure); multivariate logistic regression analysis was used to identify predictors of ALI and hospital mortality.
There were 71 patients included in this study. The overall VA ECMO hospital mortality was 53.5%. ALI was seen in 14 (19.7%) patients. Of these, four (5.6%) patients had fasciotomy, four patients (5.6%) had thrombectomy, and one underwent arterial repair (1.4%). Five additional patients (7.0%) with ALI expired and had no vascular intervention. None of the demographic and clinical characteristics significantly correlated with ALI except for stroke and renal failure requiring new-onset hemodialysis (HD). The rate of hospital and 6-month mortality in patients with and without vascular complications were 78.6%, 92.3% and 47.4%, 57.4%, respectively (P = 0.042 and P = 0.023). Multivariate analysis correlated hospital and six-month mortality with ALI, stroke, and new-onset HD.
ALI correlates with higher mortality in VA ECMO patients with femoral cannulation. Although some of the contributing factors to mortality in these patients are related to the consequences of cardiopulmonary failure, strong efforts should be made to avoid ALI after femoral VA ECMO cannulation.
体外膜肺氧合（ECMO）是一种用于挽救心肺功能衰竭患者生命的治疗手段，其应用日益广泛。然而，ECMO本身也存在一些严重并发症。死亡率仍然很高，在存活患者中，中风、肾衰竭和急性肢体威胁性缺血（ALI）等并发症很常见。我们分析了这些并发症之一——ALI对接受股动脉插管静脉-动脉ECMO（VA ECMO）患者生存情况的影响。
本研究纳入了2010年12月至2017年12月期间在两家机构接受经股动脉插管VA ECMO支持的心肺功能衰竭患者。数据采用回顾性收集。我们的主要结局是ALI及其对医院死亡率的影响。次要结局包括6个月死亡率、住院时间和其他并发症（中风和肾衰竭）；采用多因素逻辑回归分析来确定ALI和医院死亡率的预测因素。
本研究共纳入71例患者。VA ECMO患者的总体医院死亡率为53.5%。14例（19.7%）患者出现ALI。其中，4例（5.6%）患者接受了筋膜切开术，4例（5.6%）患者接受了血栓切除术，1例（1.4%）患者接受了动脉修复术。另外5例（7.0%）ALI患者死亡，未接受血管干预。除了中风和需要新发血液透析（HD）的肾衰竭外，没有其他人口统计学和临床特征与ALI显著相关。有血管并发症和无血管并发症患者的医院死亡率和6个月死亡率分别为78.6%、92.3%和47.4%、57.4%（P = 0.042和P = 0.023）。多因素分析表明，医院死亡率和6个月死亡率与ALI、中风和新发HD相关。
在接受股动脉插管的VA ECMO患者中，ALI与较高的死亡率相关。虽然这些患者死亡的一些促成因素与心肺功能衰竭的后果有关，但应大力努力避免在股动脉VA ECMO插管后发生ALI。
