Magunia Harry, Haeberle Helene A, Henn Philipp, Mehrländer Martin, Vlatten Peer O, Mirakaj Valbona, Rosenberger Peter, Koeppen Michael
Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany.
Crit Care Res Pract. 2020 Mar 7;2020:6958152. doi: 10.1155/2020/6958152. eCollection 2020.
Extracorporeal membrane oxygenation (ECMO) serves as a rescue therapy when systemic hypoxia persists despite conventional care for severe acute respiratory distress syndrome (ARDS). Due to the extracorporeal gas exchange, the O/ O ratio cannot be used as the primary marker for disease severity and progression. Therefore, we performed a propensity score-matched analysis to identify other potential predictors of outcomes in patients supported by ECMO therapy.
Between December 2014 and May 2018, 105 patients underwent venovenous ECMO in our institution. From these patients, we identified 28 who died during ECMO therapy and assigned 28 control patients using propensity score matching based on the following criteria: age, ARDS severity, and SAPSII score at admission. A statistical evaluation of the patient characteristics, intensive care data, morbidities, respiratory system variables, and outcomes was performed. The baseline patient characteristics did not differ between groups and ECMO was placed on day 1 in all patients. The analyzed variables of respiratory mechanics, such as the plateau pressure, positive end-expiratory pressure, and tidal volume, did not differ between groups. The driving pressure before ECMO was equal between the nonsurvivors and the controls. Twelve hours after initiation of ECMO therapy, the driving pressure decreased by 40.8% in the survivors but by only 20.1% in the nonsurvivors.
We report that very early driving pressure changes can serve as an indicator of disease severity and predict patient survival following ECMO therapy.
对于严重急性呼吸窘迫综合征（ARDS），尽管采取了常规治疗，但如果系统性缺氧仍然存在，体外膜肺氧合（ECMO）可作为一种挽救疗法。由于体外气体交换，氧合指数（O/ O ratio）不能用作疾病严重程度和进展的主要标志物。因此，我们进行了倾向评分匹配分析，以确定接受ECMO治疗患者其他潜在的预后预测因素。
2014年12月至2018年5月期间，我院105例患者接受了静脉-静脉ECMO治疗。从这些患者中，我们确定了28例在ECMO治疗期间死亡的患者，并根据以下标准使用倾向评分匹配法分配了28例对照患者：年龄、ARDS严重程度和入院时的简化急性生理学评分II（SAPSII）。对患者特征、重症监护数据、发病率、呼吸系统变量和预后进行了统计学评估。两组患者的基线特征无差异，所有患者均在第1天开始使用ECMO。两组之间分析的呼吸力学变量，如平台压、呼气末正压和潮气量，没有差异。在非幸存者和对照组中，ECMO前的驱动压相等。在开始ECMO治疗12小时后，幸存者的驱动压下降了40.8%，而非幸存者仅下降了20.1%。
我们报告，早期驱动压变化可作为疾病严重程度的指标，并预测ECMO治疗后的患者生存情况。
