Merritt-Genore HelenMari, Schwabe Michael, Luksan Abel, Ryan Timothy, Lyden Elizabeth, Moulton Michael
Division of Cardiothoracic Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
University of Nebraska Medical School, Omaha, Nebraska.
J Card Surg. 2020 Sep;35(9):2208-2215. doi: 10.1111/jocs.14715. Epub 2020 Jul 27.
Postcardiotomy extracorporeal membrane oxygenation (PC-ECMO) represents a unique subset of critically ill patients, with a paucity of data regarding long-term survival and correlated characteristics. We present a retrospective cohort of PC-ECMO patients, with outcomes at 1 and 3 years.
Data were collected retrospectively for all patients requiring ECMO within 72 hours of an index cardiac operation (excluding assist devices and transplants). Primary outcomes were the ability to wean from ECMO, hospital survival, and long-term survival.
Thirty-one patients required PC-ECMO, representing a total of 172 days of ECMO support. Overall survival data were the ability to wean 58%, hospital survival 52%, 1-month survival 42%. The estimated 12- and 36-month survival for all PC-ECMO patients was 35% and 29%, respectively. Twelve and 36-month survival for all hospital survivors was 62% and 56%. Operative times, the Society of Thoracic Surgeons risk scores, type of operation, open chest status, hemorrhage, and cannulation location, and timing were all compared. Centrally cannulated patients were more likely to wean from ECMO (83% vs 44%; P = .03), and survive hospitalization (75% vs 36%; P = .04) and trended toward long-term survival benefit (67% vs 33%; P = .06). Otherwise, no statistically significant relationships were observed.
Central cannulation may provide benefits in the postcardiotomy patient, compared to peripheral strategies. Twelve and 36-month survival for all PC-ECMO patients was 35% and 29%. For hospital survivors, 12 and 36-month survival 62% 56% at 36. These data support PC-ECMO as a reasonable salvage strategy, with midterm survival comparable to other surgically treated diseases.
心脏术后体外膜肺氧合（PC-ECMO）代表了一类特殊的危重症患者群体，关于其长期生存及相关特征的数据较少。我们呈现了一组PC-ECMO患者的回顾性队列研究，报告了其1年和3年的预后情况。
回顾性收集所有在心脏手术索引后72小时内需要ECMO的患者数据（不包括辅助装置和移植手术）。主要结局指标为脱机能力、住院生存率和长期生存率。
31例患者需要PC-ECMO，共接受了172天的ECMO支持。总体生存数据显示脱机能力为58%，住院生存率为52%，1个月生存率为42%。所有PC-ECMO患者的12个月和36个月生存率估计分别为35%和29%。所有住院幸存者的12个月和36个月生存率分别为62%和56%。比较了手术时间、胸外科医师协会风险评分、手术类型、开胸状态、出血情况、插管位置和时机等。中心插管患者更有可能脱机（83%对44%；P = 0.03）、存活至出院（75%对36%；P = 0.04），且有长期生存获益的趋势（67%对33%；P = 0.06）。否则，未观察到具有统计学意义的相关性。
与外周策略相比，中心插管可能对心脏术后患者有益。所有PC-ECMO患者的12个月和36个月生存率分别为35%和29%。对于住院幸存者，36个月时的12个月和36个月生存率分别为62%和56%。这些数据支持将PC-ECMO作为一种合理的挽救策略，其中期生存率与其他外科治疗疾病相当。
