Benseghir Y, Sebestyan A, Durand M, Bennani F, Bédague D, Chavanon O
Service de chirurgie cardiaque, Pôle thorax-vaisseaux - CHU Grenoble Alpes, Grenoble, France.
Service de chirurgie cardiaque, Pôle thorax-vaisseaux - CHU Grenoble Alpes, Grenoble, France.
Ann Cardiol Angeiol (Paris). 2021 Apr;70(2):63-67. doi: 10.1016/j.ancard.2020.10.006. Epub 2021 Feb 24.
The objective of our study is to detail our experience relating to ECMO implantations for post-cardiotomy refractory shock, by analyzing the pre-ECMO factors (history, type of surgery, LVEF), factors relating to ECMO (implantation time, duration) and post-ECMO factors (weaning, complications) in order to highlight those possibly associated with high mortality.
This is a univariate and multivariate retrospective study of ECMO data implemented between 2011 and 2019 at the Grenoble Alpes University Hospital Center following cardiac surgery. The time to implantation of ECMO was less than 3hours (intraoperative) between 3 and 24hours (early postoperative) and between 24 and 48hours after aortic unclamping (late postoperative). Preoperative or postoperative intra-aortic balloon counterpulsation (CPBIA) could be associated.
114 veino-arterial ECMOs were implanted for refractory cardiogenic shock after 5702 cardiac surgeries (1.9%) with a survival rate of 30.7%. The mean age of the patients was 68.6+- 10.5 years. The implantation of ECMO was performed intraoperatively in 71 patients (62.2%), early postoperatively in 22 patients (19.2%) and late postoperatively in 21 patients (18.4%). The duration of assistance was less than 48hours in 27 patients (23.6%), between 48hours and one week in 58 patients (50.9%) and more than one week in 29 patients (25.5%). Univariate analysis revealed a statistically significant association between mortality rate and male sex (P=0.002), association absent with other preoperative characteristics, delay in implantation of ECMO, installation of CPBIA, post-operative characteristics and resuscitation suites. Multivariate analysis of the entire study population demonstrated that the use of ECMO for cardio-respiratory arrest was the only independent risk factor for mortality (OR=7.57 [1.41-40, 62]). After multivariate reanalysis excluding patients with ECMO placement for cardio respiratory arrest, age, preoperative renal failure, type of procedure and EuroSCORE II were risk factors for mortality.
In this study, male gender, type of intervention, occurrence of cardiac arrest were significantly associated with the death rate. A study of greater power, multicentric, and with a larger sample, will have to be carried out to reach significance.
我们研究的目的是详细阐述体外膜肺氧合（ECMO）植入治疗心脏术后难治性休克的经验，通过分析体外膜肺氧合植入前的因素（病史、手术类型、左心室射血分数）、与体外膜肺氧合相关的因素（植入时间、持续时间）以及体外膜肺氧合植入后的因素（撤机、并发症），以突出那些可能与高死亡率相关的因素。
这是一项对2011年至2019年在格勒诺布尔阿尔卑斯大学医院中心心脏手术后实施的体外膜肺氧合数据进行的单因素和多因素回顾性研究。体外膜肺氧合的植入时间在3小时以内（术中）、3至24小时（术后早期）以及主动脉阻断后24至48小时（术后晚期）。术前或术后主动脉内球囊反搏（IABP）可能与之相关。
在5702例心脏手术后，114例患者因难治性心源性休克植入了静脉-动脉体外膜肺氧合（1.9%），生存率为30.7%。患者的平均年龄为68.6±10.5岁。71例患者（62.2%）在术中植入体外膜肺氧合，22例患者（19.2%）在术后早期植入，21例患者（18.4%）在术后晚期植入。27例患者（23.6%）的辅助时间少于48小时，58例患者（50.9%）的辅助时间在48小时至1周之间，29例患者（25.5%）的辅助时间超过1周。单因素分析显示死亡率与男性性别之间存在统计学显著关联（P=0.002），与其他术前特征、体外膜肺氧合植入延迟、主动脉内球囊反搏的安装、术后特征和复苏室无关。对整个研究人群的多因素分析表明，因心肺骤停使用体外膜肺氧合是唯一的独立死亡风险因素（OR=7.57[1.41-40.62]）。在排除因心肺骤停而植入体外膜肺氧合的患者后进行多因素重新分析，年龄、术前肾衰竭、手术类型和欧洲心脏手术风险评估系统II（EuroSCORE II）是死亡风险因素。
在本研究中，男性性别、干预类型、心脏骤停的发生与死亡率显著相关。必须进行一项规模更大、多中心、样本量更大的研究才能得出有统计学意义的数据。
