心脏骤停体外生命支持治疗成人患者的亚低温治疗对出血事件的影响。
Impact of therapeutic hypothermia on bleeding events in adult patients treated with extracorporeal life support peri-cardiac arrest.
机构信息
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, 585 University Avenue, Toronto, ON M5G 2N2, Canada.
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
出版信息
J Crit Care. 2021 Apr;62:12-18. doi: 10.1016/j.jcrc.2020.11.008. Epub 2020 Nov 16.
PURPOSE
Whether therapeutic hypothermia (TH) adds to the risk of bleeding in patients on extracorporeal life support (ECLS) peri-cardiac arrest remains unknown.
MATERIAL AND METHODS
Single center retrospective study on patients receiving veno-arterial ECLS peri-cardiac arrest ± TH at 32-34 °C (January 2009-December 2015).
PRIMARY OUTCOME
major bleeding (including intracerebral hemorrhage, ICH) < 72 h of cardiac arrest. Logistic regression and marginal structural models were used to analyze associations with major bleeding.
RESULTS
Of 66 patients receiving ECLS, 36 were treated with TH. Major bleeding occurred in 14 patients (39%) treated with ECLS+TH and in 17 patients (57%) with ECLS alone. ICH was reported in 3 (8%) and one patient (3%), respectively. There was no difference in mortality, but lung injury occurred more often in ECLS+TH. A platelet count <60 × 10/L but not TH was associated with major bleeding (including ICH). The estimated causal risk ratio of TH on the occurrence of major bleeding (including ICH) at 72 h post cardiac arrest was 0.95 (95%CI 0.62-1.45).
CONCLUSIONS
Bleeding complications were common in our study. However, TH (32-34 °C) was not associated with an increased risk of major bleeding in patients on ECLS peri-cardiac arrest.
目的
心脏骤停后体外生命支持（ECLS）期间行治疗性低温（TH）是否会增加出血风险仍不清楚。
材料和方法
对 2009 年 1 月至 2015 年 12 月期间行心肺复苏后接受静脉-动脉 ECLS±32-34°C 治疗性低温的患者进行单中心回顾性研究。
主要结局
心脏骤停后<72 小时发生的主要出血（包括颅内出血，ICH）。采用逻辑回归和边缘结构模型分析与主要出血的关联。
结果
在接受 ECLS 的 66 例患者中，有 36 例接受 TH 治疗。接受 ECLS+TH 治疗的 14 例患者（39%）和接受 ECLS 单独治疗的 17 例患者（57%）发生主要出血。ICH 分别报告 3 例（8%）和 1 例（3%）。两组死亡率无差异，但 ECLS+TH 组肺部损伤更常见。血小板计数<60×10/L但不是 TH 与主要出血（包括 ICH）有关。心脏骤停后 72 小时 TH 对主要出血（包括 ICH）发生的估计因果风险比为 0.95（95%CI 0.62-1.45）。
结论
本研究中出血并发症常见。然而，TH（32-34°C）与心肺复苏后接受 ECLS 治疗的患者的主要出血风险增加无关。
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