体外膜肺氧合治疗的成年患者中的中枢神经系统并发症。

CNS Complications in Adult Patients Treated With Extracorporeal Membrane Oxygenation.

机构信息

Intensive Care Unit, St Vincent's Hospital, Darlinghurst, NSW, Australia.

The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.

出版信息

Crit Care Med. 2021 Feb 1;49(2):282-291. doi: 10.1097/CCM.0000000000004789.

DOI:10.1097/CCM.0000000000004789

PMID:33332815

Abstract

OBJECTIVES

To describe the incidence and outcomes of radiologically confirmed acute CNS complications in extracorporeal membrane oxygenation patients at an Australian extracorporeal membrane oxygenation referral center and identify associated patient characteristics.

DESIGN

Retrospective cohort study.

SETTING

Single-center tertiary institution.

PATIENTS

Four-hundred twelve consecutive adult patients supported with extracorporeal membrane oxygenation from 2009 to 2017.

RESULTS

Fifty-five patients (13.3%) had a CNS complication confirmed by CT or MRI, including ischemic stroke (7.0%), intracerebral hemorrhage (3.4%), hypoxic ischemic encephalopathy (3.6%), and spinal cord injury (1.2%). CNS complication rates in the venoarterial, venovenous, and veno-pulmonary artery extracorporeal membrane oxygenation subgroups were 18.0%, 4.6%, and 13.6%, respectively. Neurologic complications were independently associated with the use of venoarterial extracorporeal membrane oxygenation (p = 0.002) and renal replacement therapy (p = 0.04). Sixty-five percent of patients with a neurologic complication died during their hospital admission compared with 32% of patients without this complication (p < 0.001). Venoarterial extracorporeal membrane oxygenation, renal replacement therapy, and days of extracorporeal membrane oxygenation support were also associated with hospital mortality and remained so after adjustment in a multivariable regression model (p = 0.01, p < 0.001, and p = 0.003, respectively).

CONCLUSIONS

CNS complications appear to occur more frequently in patients requiring circulatory as opposed to respiratory support on extracorporeal membrane oxygenation and are independently associated with mortality. It remains unclear if these complications are causative of a poor outcome or a marker of severity of the underlying condition. Further research is required to better elucidate modifiable or preventable aspects through better patient selection and change in ongoing care.

摘要

目的

描述澳大利亚体外膜肺氧合（ECMO）转介中心接受 ECMO 治疗的患者中放射学确诊的急性中枢神经系统（CNS）并发症的发生率和结局，并确定相关的患者特征。

方法

回顾性队列研究。

地点

单中心三级机构。

患者

2009 年至 2017 年期间，412 例连续接受 ECMO 支持的成年患者。

结果

55 例（13.3%）患者的 CNS 并发症经 CT 或 MRI 证实，包括缺血性脑卒中（7.0%）、颅内出血（3.4%）、缺氧缺血性脑病（3.6%）和脊髓损伤（1.2%）。静脉-动脉、静脉-静脉和静脉-肺动脉 ECMO 亚组的 CNS 并发症发生率分别为 18.0%、4.6%和 13.6%。神经系统并发症与静脉-动脉 ECMO 的使用（p = 0.002）和肾脏替代治疗（p = 0.04）独立相关。与无神经系统并发症的患者相比，发生神经系统并发症的患者在住院期间的死亡率为 65%，而无神经系统并发症的患者死亡率为 32%（p < 0.001）。静脉-动脉 ECMO、肾脏替代治疗和 ECMO 支持天数也与住院死亡率相关，且在多变量回归模型调整后仍如此（p = 0.01、p < 0.001 和 p = 0.003）。