Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France.
Sorbonne Université, UMR INSERM 1166, IHU ICAN, AP-HP, Department of Cardio-Vascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France.
J Cardiothorac Vasc Anesth. 2021 Jan;35(1):41-47. doi: 10.1053/j.jvca.2020.07.069. Epub 2020 Jul 28.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) commonly is used to manage refractory cardiogenic shock after cardiac surgery, with 31% to 76% of patients successfully weaned off their ECMO. However, it is associated with high mortality rates, and 20% to 65% of weaned patients do not survive to hospital discharge. This study aimed to assess the incidence of ECMO weaning-related shock, the risk factors, and prognosis in the intensive care unit (ICU).
Retrospective observational cohort study.
Surgical ICU of Cardiology Institute of Pitié-Salpêtrière University Hospital (Paris-France).
Patients who were assisted with a peripheral VA-ECMO from January 2015 to December 2017 were included. Patients with venovenous, central, or right ECMO were excluded.
The authors collected data on patients' characteristics, during and after surgery. The indications for VA-ECMO implantation were ventricular dysfunction, primary graft dysfunction, and refractory cardiac arrest. Weaning-related shock was defined as the need to introduce or increase the dose of catecholamine at ECMO explantation or in the following week.
After weaning off VA-ECMO, 56 of 146 patients (38.4%) presented weaning-related shock: 55% were septic shocks, 12.5 % were caused by right ventricle failure, and 7.1% by hemorrhage. ICU mortality was 42% versus 8% in patients who did not present shock. Multivariate analysis showed that patients with pulmonary hypertension and those with norepinephrine before weaning were more likely to develop shock.
ECMO weaning-related shock is frequent in patients with refractory cardiogenic shock after cardiac surgery. This is most commonly caused by sepsis and causes higher mortality rates, calling for further evaluation.
体外膜肺氧合（VA-ECMO）常用于治疗心脏手术后难治性心源性休克，有 31%至 76%的患者可成功脱机 ECMO。然而，其死亡率仍然较高，20%至 65%的脱机患者无法存活至出院。本研究旨在评估重症监护病房（ICU）中 ECMO 脱机相关休克的发生率、危险因素和预后。
回顾性观察性队列研究。
巴黎皮提-萨尔佩特里埃大学医院心脏病研究所外科 ICU。
纳入 2015 年 1 月至 2017 年 12 月期间接受外周 VA-ECMO 辅助的患者。排除接受静脉-静脉、中央或右 ECMO 的患者。
作者收集了患者手术期间和手术后的特征数据。VA-ECMO 植入的指征为心室功能障碍、原发性移植物功能障碍和难治性心脏骤停。脱机相关休克定义为在 ECMO 拔出或随后一周内需要引入或增加儿茶酚胺剂量。
在 VA-ECMO 脱机后，146 例患者中有 56 例（38.4%）出现脱机相关休克：55%为脓毒性休克，12.5%由右心室衰竭引起，7.1%由出血引起。ICU 死亡率为 42%，而未发生休克的患者为 8%。多变量分析显示，肺动脉高压和脱机前使用去甲肾上腺素的患者更有可能发生休克。
心脏手术后难治性心源性休克患者 ECMO 脱机相关休克较为常见。这主要由感染引起，且导致更高的死亡率，需要进一步评估。
