Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Crit Care Med. 2021 Feb 1;49(2):e120-e129. doi: 10.1097/CCM.0000000000004762.
Intracranial hemorrhage is a serious complication in patients receiving venovenous extracorporeal membrane oxygenation during treatment of the acute respiratory distress syndrome. We analyzed timing, outcome, and risk factors of intracranial hemorrhage in patients on venovenous extracorporeal membrane oxygenation.
Retrospective cohort study.
Single acute respiratory distress syndrome referral center.
Patients receiving venovenous extracorporeal membrane oxygenation were identified from a cohort of 1,044 patients with acute respiratory distress syndrome. Patients developing an intracranial hemorrhage during venovenous extracorporeal membrane oxygenation therapy were compared with patients without evidence for intracranial hemorrhage. The primary objective was to assess the association of intracranial hemorrhage with 60-day mortality. Further objectives included the identification of risk factors for intracranial hemorrhage and the evaluation of clinical cutoff values.
None.
Among 444 patients treated with venovenous extracorporeal membrane oxygenation, 49 patients (11.0% [95% CI, 8.3-14.4%]) developed an intracranial hemorrhage. The median time to intracranial hemorrhage occurrence was 4 days (95% CI, 2-7 d). Patients who developed an intracranial hemorrhage had a higher 60-day mortality compared with patients without intracranial hemorrhage (69.4% [54.4-81.3%] vs 44.6% [39.6-49.6%]; odds ratio 3.05 [95% CI, 1.54-6.32%]; p = 0.001). A low platelet count, a high positive end expiratory pressure, and a major initial decrease of Paco2 were identified as independent risk factors for the occurrence of intracranial hemorrhage. A platelet count greater than 100/nL and a positive end expiratory pressure less than or equal to 14 cm H2O during the first 7 days of venovenous extracorporeal membrane oxygenation therapy as well as a decrease of Paco2 less than 24 mm Hg during venovenous extracorporeal membrane oxygenation initiation were identified as clinical cutoff values to prevent intracranial hemorrhage (sensitivity 91% [95% CI, 82-99%], 94% [85-99%], and 67% [48-81%], respectively).
Intracranial hemorrhage occurs early during venovenous extracorporeal membrane oxygenation and is a determinant for 60-day mortality. Appropriate adjustment of identified modifiable risk factors might lower the prevalence of intracranial hemorrhage during venovenous extracorporeal membrane oxygenation therapy.
在急性呼吸窘迫综合征（ARDS）治疗过程中，接受静脉-静脉体外膜肺氧合（VV-ECMO）的患者会出现颅内出血等严重并发症。本研究旨在分析 VV-ECMO 治疗过程中颅内出血的发生时间、结局和危险因素。
回顾性队列研究。
一家急性呼吸窘迫综合征单转诊中心。
从急性呼吸窘迫综合征患者队列中（1044 例）确定接受 VV-ECMO 的患者。将在 VV-ECMO 治疗过程中发生颅内出血的患者与未发生颅内出血的患者进行比较。主要目的是评估颅内出血与 60 天死亡率的相关性。进一步的目标包括确定颅内出血的危险因素和评估临床临界值。
无。
在接受 VV-ECMO 治疗的 444 例患者中，49 例（11.0%[95%CI，8.3-14.4%]）发生颅内出血。颅内出血发生的中位时间为 4 天（95%CI，2-7d）。与未发生颅内出血的患者相比，发生颅内出血的患者 60 天死亡率更高（69.4%[54.4-81.3%] vs 44.6%[39.6-49.6%]；比值比 3.05[95%CI，1.54-6.32%]；p=0.001）。血小板计数低、呼气末正压高和初始 Paco2 明显下降被确定为颅内出血发生的独立危险因素。在 VV-ECMO 治疗的前 7 天，血小板计数>100/nL 和呼气末正压≤14cmH2O 以及在 VV-ECMO 启动时 Paco2 降低<24mmHg 可作为预防颅内出血的临床临界值（敏感性分别为 91%[95%CI，82-99%]、94%[85-99%]和 67%[48-81%]）。
颅内出血在 VV-ECMO 治疗过程中早期发生，是 60 天死亡率的决定因素。适当调整已确定的可改变危险因素可能会降低 VV-ECMO 治疗过程中颅内出血的发生率。
