Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Vic, Australia; Department of Surgery, Monash University, Melbourne, Vic, Australia.
Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Vic, Australia.
Heart Lung Circ. 2020 Dec;29(12):1865-1872. doi: 10.1016/j.hlc.2020.05.092. Epub 2020 Jun 23.
Over the last two decades, technological advancements in the delivery of extra corporeal membrane oxygenation (ECMO) have seen its use broaden and results improve. However, in the post cardiotomy ECMO patient group, survival remains very poor without significant improvements over the last two decades. Our study aims to report on the Australian experience, with the intention of providing background data for the formation of guidelines in the future.
Retrospective analysis of prospectively collected data from the Australian and New Zealand Society of Cardiothoracic Surgeons (ANZSCTS) Database was performed. The ANZSCTS database captures at least 60% of cardiac surgical data in Australia, annually. Data was collected on adult patients who received ECMO post cardiotomy from September 2016 to November 2017 inclusive. Transplant and primary cardiomyopathy patients were excluded.
Of the 16,605 adult patients undergoing cardiac surgery in the 15-month period of the study, 87 patients required post cardiotomy ECMO (0.52%). The average age of the entire cohort was 56 years. Overall survival to discharge was 43.7% (n=38). Multivariable logistic regression analysis demonstrated that multiorgan failure (MOF), increasing age and longer cardiopulmonary bypass time were significant predictors of in hospital mortality.
Post cardiotomy ECMO support is an uncommon condition. Survival in this study appears to be better than historical reports. Identification of poor prognostic indicators in this study may help inform the development of guidelines for the most appropriate use of this support modality.
在过去的二十年中，体外膜肺氧合（ECMO）技术的进步使其应用范围扩大，治疗效果得到改善。然而，在心脏手术后接受 ECMO 的患者群体中，尽管过去二十年没有显著改善，但存活率仍然非常低。我们的研究旨在报告澳大利亚的经验，旨在为未来制定指南提供背景数据。
对澳大利亚和新西兰心胸外科协会（ANZSCTS）数据库前瞻性收集的数据进行回顾性分析。该数据库每年至少捕获澳大利亚 60%的心脏手术数据。该研究纳入了 2016 年 9 月至 2017 年 11 月期间接受心脏手术后 ECMO 的成年患者。排除了移植和原发性心肌病患者。
在 15 个月的研究期间，接受心脏手术的 16605 名成年患者中，有 87 名患者需要心脏手术后 ECMO（0.52%）。整个队列的平均年龄为 56 岁。出院时的总生存率为 43.7%（n=38）。多变量逻辑回归分析表明，多器官衰竭（MOF）、年龄增长和体外循环时间延长是住院死亡率的显著预测因素。
心脏手术后 ECMO 支持是一种罕见的情况。本研究中的存活率似乎优于历史报告。本研究中识别出的预后不良指标可能有助于为这种支持方式的最佳使用制定指南。
