Department of Pediatrics, The Heart Institute, 2518Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Department of Cardiology, 1862Boston Children's Hospital, Boston, MA, USA.
J Intensive Care Med. 2022 Feb;37(2):195-201. doi: 10.1177/0885066620981903. Epub 2020 Dec 22.
When patients deteriorate after decannulation from extracorporeal membrane oxygenation (ECMO), a second run of extracorporeal support may be considered. However, repeat cannulation can be difficult and poor outcomes associated with multiple ECMO runs are a concern. The aim of this study was to evaluate outcomes and identify factors associated with survival and mortality in cases of multiple runs of extracorporeal membrane oxygenation.
Retrospective cohort analysis of the Extracorporeal Life Support Organization Registry.
The Extracorporeal Life Support Organization's registry was queried for neonates, children, and adults receiving 2 or more runs of ECMO during the same hospitalization, for any indication, from 1998 to 2015.
1,818 patients from the Extracorporeal Life Support Organization Registry.
Of the 1,818 patients, 1,648 underwent 2 runs and 170 underwent 3 or more runs of ECMO. The survival to discharge rate was 36.7% for 2 runs and 29.4% for 3 or more runs. No significant differences in survival were detected in analysis by decade of ECMO run (p = 0.21). Pediatric patients had less mortality than adults (OR: 0.45, 95%CI: 0.24-0.82). Cardiac support on the first run portrayed worse mortality than pulmonary support regardless of final run indication (OR:1.38, 95%CI: 1.09-1.75). Across all age groups, patients receiving pulmonary support on the last run tended to have higher survival rates regardless of support type on the first run. The only first run complication independently predictive of mortality on the final run was renal complications (OR: 1.60, 95%CI: 1.28-1.99).
Though the use of multiple runs of ECMO is growing, outcomes remain poor for most cohorts. Survival decreases with each additional run. Patients requiring additional runs for a pulmonary indication should be considered prime candidates. Renal complications on the first run significantly increases the risk of mortality on subsequent runs, and as such, careful consideration should be applied in these cases.
当患者从体外膜肺氧合（ECMO）脱机后恶化时，可能会考虑再次进行体外支持。然而，重复插管可能很困难，并且多次 ECMO 运行相关的不良预后是一个关注点。本研究的目的是评估多次 ECMO 运行的结果，并确定与生存和死亡率相关的因素。
对体外生命支持组织登记处进行回顾性队列分析。
从 1998 年至 2015 年，体外生命支持组织登记处对因任何原因在同一次住院期间接受 2 次或以上 ECMO 运行的新生儿、儿童和成人进行了查询。
来自体外生命支持组织登记处的 1818 名患者。
在 1818 名患者中，1648 名患者进行了 2 次运行，170 名患者进行了 3 次或更多次 ECMO 运行。2 次运行的出院生存率为 36.7%，3 次或更多次运行的出院生存率为 29.4%。通过 ECMO 运行的十年分析，未发现生存率有显著差异（p=0.21）。儿科患者的死亡率低于成人（OR：0.45，95%CI：0.24-0.82）。无论最终运行指征如何，第一次运行的心脏支持比肺支持的死亡率更高（OR：1.38，95%CI：1.09-1.75）。在所有年龄组中，最后一次运行接受肺支持的患者无论第一次运行的支持类型如何，其生存率往往更高。唯一可独立预测最后一次运行死亡率的第一次运行并发症是肾脏并发症（OR：1.60，95%CI：1.28-1.99）。
尽管多次 ECMO 的使用正在增加，但大多数患者的预后仍然较差。随着每次额外运行，生存率会下降。对于需要额外运行肺指征的患者，应考虑为主要候选者。第一次运行中的肾脏并发症显著增加了随后运行的死亡率风险，因此应在这些情况下慎重考虑。
