Scherer Clemens, Kupka Danny, Stocker Thomas J, Joskowiak Dominik, Scheuplein Hanna, Schönegger Carmen Maria, Born Frank, Stremmel Christopher, Lüsebrink Enzo, Stark Konstantin, Orban Mathias, Petzold Tobias, Peterss Sven, Hausleiter Jörg, Hagl Christian, Massberg Steffen, Orban Martin
Intensive Care Unit and Department of Cardiology, University Hospital, LMU Munich, Munich, Germany.
DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, University Hospital, LMU Munich, Munich, Germany.
Crit Care Explor. 2020 Mar 24;2(3):e0086. doi: 10.1097/CCE.0000000000000086. eCollection 2020 Mar.
The feasibility and hemodynamic effects of isoflurane sedation in cardiogenic shock in the presence of venoarterial extracorporeal membrane oxygenation treatment are currently unknown.
Retrospective single-center study.
Cardiac ICU of Munich university hospital.
PATIENTS/SUBJECTS: Cardiogenic shock patients with venoarterial extracorporeal membrane oxygenation treatment under sedation with volatile isoflurane between November 2018 and October 2019 have been enrolled in this study and were matched by propensity score in a 1:1 ratio with IV sedated patients treated between January 2013 and November 2018 from the cardiogenic shock registry of the university hospital of Munich.
Isoflurane sedation was used in 32 patients with cardiogenic shock and venoarterial extracorporeal membrane oxygenation treatment. The mean age of conventionally sedated patients was 58.4 ± 13.8 years and 56.3 ± 11.5 years for patients with isoflurane sedation ( = 0.51). Administration of isoflurane was associated with lower IV sedative drug use during venoarterial extracorporeal membrane oxygenation treatment (86% vs 32%; = 0.01). Mean systolic arterial pressure was similar (94.3 ± 12.6 vs 92.9 ± 10.5 mm Hg; = 0.65), but mean heart rate was significantly higher in the conventional sedation group, when compared with the isoflurane group (85.2 ± 20.5 vs 74.7 ± 15.0 beats/min; = 0.02). Catecholamine doses, venoarterial extracorporeal membrane oxygenation blood and gas flow, ventilation time (304 ± 143 vs 398 ± 272 hr; = 0.16), bleeding complications bleeding academic research consortium 3a or higher (59.3% vs 65.3%; = 0.76), and 30-day mortality (59.2% vs 63.4%, = 0.80) were similar in both groups. The overall sedation costs per patient were significantly lower in the conventional group, when compared with the isoflurane group (537 ± 624 vs 1280 ± 837 €; < 0.001).
Volatile sedation with isoflurane is feasible-albeit at higher costs-in patients with cardiogenic shock and venoarterial extracorporeal membrane oxygenation treatment and was not associated with higher catecholamine dosage or extracorporeal membrane oxygenation flow rate compared with IV sedation.
目前尚不清楚在静脉 - 动脉体外膜肺氧合治疗下心源性休克患者中使用异氟烷镇静的可行性及血流动力学效应。
回顾性单中心研究。
慕尼黑大学医院心脏重症监护病房。
患者/受试者：纳入了2018年11月至2019年10月期间在挥发性异氟烷镇静下接受静脉 - 动脉体外膜肺氧合治疗的心源性休克患者，并按倾向评分以1:1的比例与2013年1月至2018年11月期间在慕尼黑大学医院心源性休克登记处接受静脉镇静治疗的患者进行匹配。
32例心源性休克并接受静脉 -动脉体外膜肺氧合治疗的患者使用了异氟烷镇静。传统镇静患者的平均年龄为58.4±13.8岁，异氟烷镇静患者为56.3±11.5岁（P = 0.51）。在静脉 - 动脉体外膜肺氧合治疗期间，使用异氟烷与较低的静脉镇静药物使用相关（86%对32%；P = 0.01）。平均收缩压相似（94.3±12.6对92.9±10.5 mmHg；P = 0.65），但与异氟烷组相比，传统镇静组的平均心率显著更高（85.2±20.5对74.7±15.0次/分钟；P = 0.02）。两组的儿茶酚胺剂量、静脉 - 动脉体外膜肺氧合的血液和气体流量、通气时间（304±143对398±272小时；P = 0.16）、出血学术研究联盟3a级或更高等级的出血并发症（59.3%对65.3%；P = 0.76）以及30天死亡率（59.2%对63.4%，P = 0.80）相似。与异氟烷组相比，传统组每位患者的总体镇静成本显著更低（537±624对1280±837欧元；P<0.001）。
对于心源性休克并接受静脉 - 动脉体外膜肺氧合治疗的患者，使用异氟烷进行挥发性镇静是可行的——尽管成本较高——并且与静脉镇静相比，不会导致更高的儿茶酚胺剂量或体外膜肺氧合流速。
