Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina.
Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina.
J Card Fail. 2021 Mar;27(3):327-337. doi: 10.1016/j.cardfail.2020.11.026. Epub 2021 Jan 13.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a life-saving therapy for patients with cardiovascular collapse, but identifying patients unlikely to benefit remains a challenge.
We created the RESCUE registry, a retrospective, observational registry of adult patients treated with VA-ECMO between January 2007 and June 2017 at 3 high-volume centers (Columbia University, Duke University, and Washington University) to describe short-term patient outcomes. In 723 patients treated with VA-ECMO, the most common indications for deployment were postcardiotomy shock (31%), cardiomyopathy (including acute heart failure) (26%), and myocardial infarction (17%). Patients frequently suffered in-hospital complications, including acute renal dysfunction (45%), major bleeding (41%), and infection (33%). Only 40% of patients (n = 290) survived to discharge, with a minority receiving durable cardiac support (left ventricular assist device [n = 48] or heart transplantation [n = 7]). Multivariable regression analysis identified risk factors for mortality on ECMO as older age (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.12-1.42) and female sex (OR, 1.44; 95% CI, 1.02-2.02) and risk factors for mortality after decannulation as higher body mass index (OR 1.17; 95% CI, 1.01-1.35) and major bleeding while on ECMO support (OR, 1.92; 95% CI, 1.23-2.99).
Despite contemporary care at high-volume centers, patients treated with VA-ECMO continue to have significant in-hospital morbidity and mortality. The optimization of outcomes will require refinements in patient selection and improvement of care delivery.
静脉-动脉体外膜肺氧合（VA-ECMO）越来越多地被用作治疗心血管衰竭患者的救命疗法，但识别不太可能受益的患者仍然是一个挑战。
我们创建了 RESCUE 登记处，这是一项回顾性、观察性登记处，记录了 2007 年 1 月至 2017 年 6 月期间在 3 个高容量中心（哥伦比亚大学、杜克大学和华盛顿大学）接受 VA-ECMO 治疗的成年患者的短期患者结局。在 723 例接受 VA-ECMO 治疗的患者中，最常见的部署指征是心脏手术后休克（31%）、心肌病（包括急性心力衰竭）（26%）和心肌梗死（17%）。患者经常出现院内并发症，包括急性肾功能障碍（45%）、大出血（41%）和感染（33%）。只有 40%的患者（n=290）存活出院，少数患者接受了持久的心脏支持（左心室辅助装置[n=48]或心脏移植[n=7]）。多变量回归分析确定了 ECMO 死亡率的危险因素为年龄较大（比值比[OR]，1.26；95%置信区间[CI]，1.12-1.42）和女性（OR，1.44；95% CI，1.02-2.02），以及脱机后死亡率的危险因素为较高的体重指数（OR 1.17；95% CI，1.01-1.35）和 ECMO 支持期间的大出血（OR，1.92；95% CI，1.23-2.99）。
尽管在高容量中心进行了现代治疗，但接受 VA-ECMO 治疗的患者仍有显著的院内发病率和死亡率。优化结果需要改进患者选择和改善护理提供。
