From the Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital, St. Louis, Missouri.
ASAIO J. 2021 Jan 1;67(1):25-31. doi: 10.1097/MAT.0000000000001192.
Extracorporeal life support (ECLS) can result in complications due to increased left ventricular (LV) afterload. The percutaneous ventricular assist device (PVAD) and intra-aortic balloon pump (IABP) are both considered to be effective means of LV unloading. This study describes the efficacy of LV unloading and related outcomes with PVAD or IABP during ECLS. From January 2010 to April 2018, all cardiogenic shock patients who underwent ECLS plus simultaneous PVAD or IABP were analyzed. Forty-nine patients received ECLS + PVAD, while 91 received ECLS + IABP. At 48 hours, mean pulmonary artery pressure was significantly reduced in both groups [34 mm Hg to 22, p < 0.01; 32 mm Hg to 21, p < 0.01; ECLS + PVAD and ECLS + IABP group, respectively]. The two groups had similar 30 day survival rates [19 patients (39%) vs. 35 (39%), p = 0.56]. The ECLS + PVAD group had higher incidences of bleeding at the insertion site [11 (22%) vs. 0, p < 0.01] and major hemolysis [9 (18%) vs. 0, p < 0.01]. Both groups had improvement in LV end-diastolic dimension (61 ± 12 mm to 54 ± 12, p = 0.03; 60 ± 12 mm to 47 ± 10, p < 0.01), and LV ejection fraction (16 ± 7% to 22 ± 10, p < 0.01; 22 ± 12% to 29 ± 15, p = 0.01). Both ECLS + PVAD and ECLS + IABP effectively reduced pulmonary artery pressure and improved LV function. Bleeding at the PVAD or IABP insertion site occurred more frequently in the ECLS + PVAD group than the ECLS + IABP group (p < 0.01). Nine patients (18%) in the ECLS + PVAD group experienced major hemolysis, while there was no hemolysis in the ECLS + IABP group (p < 0.01). Careful considerations are required before selecting an additional support to ECLS.
体外生命支持 (ECLS) 可导致左心室 (LV) 后负荷增加而产生并发症。经皮心室辅助装置 (PVAD) 和主动脉内球囊泵 (IABP) 均被认为是有效减轻 LV 负荷的手段。本研究描述了 ECLS 期间使用 PVAD 或 IABP 减轻 LV 负荷的效果及相关结果。
从 2010 年 1 月至 2018 年 4 月，所有接受 ECLS 加同时 PVAD 或 IABP 的心源休克患者均进行了分析。49 例患者接受 ECLS + PVAD，91 例患者接受 ECLS + IABP。48 小时后，两组肺动脉压均显著降低[34mmHg 降至 22mmHg，p < 0.01；32mmHg 降至 21mmHg，p < 0.01；ECLS + PVAD 和 ECLS + IABP 组]。两组 30 天存活率相似[19 例（39%）比 35 例（39%），p = 0.56]。ECLS + PVAD 组出血发生率更高[11 例（22%）比 0，p < 0.01]和主要溶血[9 例（18%）比 0，p < 0.01]。两组 LV 舒张末期内径均有改善（61±12mm 降至 54±12mm，p = 0.03；60±12mm 降至 47±10mm，p < 0.01），LV 射血分数也有改善（16±7%升至 22±10%，p < 0.01；22±12%升至 29±15%，p = 0.01）。ECLS + PVAD 和 ECLS + IABP 均能有效降低肺动脉压，改善 LV 功能。ECLS + PVAD 组 PVAD 或 IABP 插入部位出血发生率高于 ECLS + IABP 组（p < 0.01）。ECLS + PVAD 组 9 例（18%）发生严重溶血，而 ECLS + IABP 组无溶血（p < 0.01）。在选择额外的 ECLS 支持方式前，需要仔细考虑。
