体外膜肺氧合患者的血液利用与临床结局。
Blood Utilization and Clinical Outcomes in Extracorporeal Membrane Oxygenation Patients.
机构信息
From the Departments of Anesthesiology/Critical Care Medicine.
Surgery (Pediatric).
出版信息
Anesth Analg. 2020 Sep;131(3):901-908. doi: 10.1213/ANE.0000000000004807.
BACKGROUND
Patients requiring extracorporeal membrane oxygenation (ECMO) support are critically ill and have substantial transfusion requirements, which convey both risks and benefits. A retrospective analysis was conducted to assess the association between blood component administration and adverse outcomes in adult, pediatric, and neonatal ECMO patients.
METHODS
We evaluated 217 ECMO patients at a single center hospitalized between January 2009 and June 2016. Three cohorts (88 adult, 57 pediatric, and 72 neonatal patients) were included for assessment of patient characteristics, blood utilization, and clinical outcomes. Univariable and multivariable analyses were used to assess the association between transfusions and clinical outcomes (primary outcome: mortality and secondary outcomes: morbid events). The analysis included the main exposure of interest (total number of blood component units transfused) and potential confounding variables (age group cohort, case mix index, sex, ECMO mode and duration, and primary ECMO indication).
RESULTS
After adjustment for confounders, with each additional blood component unit transfused, there was an estimated increase in odds for mortality by 1% (odds ratio [OR] = 1.01; 95% confidence interval [CI], 1.00-1.02; P = .013) and an increase in odds for thrombotic events by 1% (OR = 1.01; 95% CI, 1.00-1.02; P = .007). Mortality was higher in the adult (57 of 88; 64.8%) and pediatric (37 of 57; 64.9%) than in the neonatal cohort (19 of 72; 26.4%) (P < .0001). Median total blood components transfused per day followed a similar pattern for the adult (2.3 units; interquartile range [IQR] = 0.8-7.0), pediatric (2.9 units; IQR = 1.1-10), and neonatal (1.0 units; IQR = 0.7-1.6) cohorts (P < .0001). Over the entire hospitalization, the total median blood components transfused was highest in the neonatal (41 units; IQR = 24-94) and pediatric (41 units; IQR = 17-113) compared to the adult (30 units; IQR = 9-58) cohort (P = .007). There was no significant interaction between total units transfused over the hospital stay and age cohort for mortality (P = .35).
CONCLUSIONS
Given the association between transfusion and adverse outcomes, effective blood management strategies may be beneficial in ECMO patients.
背景
需要体外膜肺氧合（ECMO）支持的患者病情危急，输血需求大，这既带来风险，也带来益处。本回顾性分析旨在评估成人、儿科和新生儿 ECMO 患者的血液成分输注与不良结局之间的关联。
方法
我们对 2009 年 1 月至 2016 年 6 月期间在一家中心医院住院的 217 例 ECMO 患者进行了评估。纳入了三个队列（88 例成人、57 例儿科和 72 例新生儿患者），以评估患者特征、血液利用情况和临床结局。采用单变量和多变量分析评估输血与临床结局（主要结局：死亡率和次要结局：不良事件）之间的关联。分析包括主要关注的暴露因素（输注的血液成分单位总数）和潜在混杂变量（年龄组队列、病例组合指数、性别、ECMO 模式和持续时间以及主要 ECMO 适应证）。
结果
在校正混杂因素后，输注的血液成分单位每增加 1 个，死亡率的估计比值比（OR）增加 1%（OR=1.01；95%置信区间[CI]，1.00-1.02；P=0.013），血栓事件的 OR 增加 1%（OR=1.01；95%CI，1.00-1.02；P=0.007）。成人（88 例中 57 例；64.8%）和儿科（57 例中 37 例；64.9%）的死亡率高于新生儿队列（72 例中 19 例；26.4%）（P<0.0001）。成人（2.3 单位；四分位间距[IQR]，0.8-7.0）、儿科（2.9 单位；IQR，1.1-10）和新生儿（1.0 单位；IQR，0.7-1.6）组每天输注的血液成分总量中位数呈相似模式（P<0.0001）。整个住院期间，新生儿（41 单位；IQR，24-94）和儿科（41 单位；IQR，17-113）的总血液成分中位数输注量均高于成人（30 单位；IQR，9-58）组（P=0.007）。在整个住院期间，总输注量与死亡率的年龄组之间无显著交互作用（P=0.35）。
结论
鉴于输血与不良结局之间的关联，有效的血液管理策略可能对 ECMO 患者有益。
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