Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
Perfusion. 2022 Oct;37(7):738-744. doi: 10.1177/02676591211020468. Epub 2021 May 26.
Clinical outcomes of cardiogenic shock patients who were supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary endarterectomy (CE) have not yet been reported. We conducted a retrospective observational study to evaluate the short-term outcomes of patients supported with VA-ECMO after CE.
Patients ( = 32) who received VA-ECMO refractory cardiogenic shock after CE between January 2011 and December 2020 at the Beijing Anzhen Hospital were reviewed retrospectively. Multivariable logistic regression analysis was used to identify factors independently associated with in-hospital mortality.
Twenty patients (63%) could be weaned from VA-ECMO, and 12 patients (38%) survived to hospital discharge. The median (interquartile range [IQR]) time on VA-ECMO support was 4 (3-6) days. The median (IQR) length of ICU stay and hospital stay were 9 (5-13) and 20 (15-27) days, respectively. Neurological complications were observed in 4 (13%) of the patients. ECMO-related complications occurred in 9 (28%) of the patients. SAVE score was identified as an independent protective factor for in-hospital mortality (OR, 0.70; 95% CI, 0.54-0.91; p = 0.009). The area under the receiver operating characteristic curve for SAVE score was 0.83 (95% CI, 0.67-0.98). SOFA score (0.78; 95% CI, 0.62-0.94) and EuroSCORE (0.79; 95% CI, 0.62-0.97) also exhibited good performances.
VA-ECMO is an acceptable technique for the treatment of cardiogenic shock in patients undergoing CE. SAVE score might be a useful tool to predict survival for these patients. Prospective studies are needed to assess long-term outcomes of hospital survivors.
经皮冠状动脉内膜切除术（CE）后接受静脉-动脉体外膜肺氧合（VA-ECMO）支持的心源性休克患者的临床结果尚未报道。我们进行了一项回顾性观察性研究，以评估 CE 后接受 VA-ECMO 支持的患者的短期结果。
回顾性分析 2011 年 1 月至 2020 年 12 月在北京安贞医院接受 CE 后出现 VA-ECMO 难治性心源性休克的 32 例患者。采用多变量逻辑回归分析确定与院内死亡率独立相关的因素。
20 例（63%）患者可以脱机 VA-ECMO，12 例（38%）患者存活至出院。VA-ECMO 支持的中位（四分位距 [IQR]）时间为 4（3-6）天。ICU 住院时间和住院时间的中位数（IQR）分别为 9（5-13）天和 20（15-27）天。4 例（13%）患者出现神经系统并发症。9 例（28%）患者发生 ECMO 相关并发症。SAVE 评分被确定为院内死亡率的独立保护因素（OR，0.70；95%CI，0.54-0.91；p=0.009）。SAVE 评分的受试者工作特征曲线下面积为 0.83（95%CI，0.67-0.98）。SOFA 评分（0.78；95%CI，0.62-0.94）和 EuroSCORE（0.79；95%CI，0.62-0.97）也表现出良好的性能。
VA-ECMO 是治疗接受 CE 治疗的心源性休克患者的一种可行技术。SAVE 评分可能是预测此类患者生存的有用工具。需要前瞻性研究来评估医院幸存者的长期结果。
