Hou Dengbang, Wang Hong, Yang Feng, Hou Xiaotong
Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Front Med (Lausanne). 2021 Aug 11;8:721774. doi: 10.3389/fmed.2021.721774. eCollection 2021.
This study aims to describe the prevalence of neurologic complications and hospital outcome in adult post-cardiotomy cardiogenic shock (PCS) patients receiving veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support and factors associated with such adverse events. Four hundred and fifteen adult patients underwent cardiac surgery and received V-A ECMO for more than 24 h because of PCS. Patients were divided into two groups: those who developed a neurological complication and those who did not (control group). Multivariable logistic regression was performed to identify factors independently associated with neurologic complications. Neurologic complications occurred in 87 patients (21.0%), including cerebral infarction in 33 patients (8.0%), brain death in 30 patients (7.2%), seizures in 14 patients (3.4%), and intracranial hemorrhage in 11 (2.7%) patients. In-hospital mortality in patients with neurologic complications was 90.8%, compared to 52.1% in control patients ( < 0.001). In a multivariable model, the lowest systolic blood pressure (SBP) level pre-ECMO (OR, 0.89; 95% CI: 0.86-0.93) and aortic surgery combined with coronary artery bypass grafting (OR, 9.22; 95% CI: 2.10-40.55) were associated with overall neurologic complications. Age (OR, 1.06; 95% CI: 1.01-1.12) and lowest SBP (OR, 0.81; 95% CI: 0.76-0.87) were correlative factors of brain death. Coagulation disorders (OR, 9.75; 95% CI: 1.83-51.89) and atrial fibrillation (OR, 12.19; 95% CI: 1.22-121.61) were shown to be associated independently with intracranial hemorrhage, whereas atrial fibrillation (OR, 8.15; 95% CI: 1.31-50.62) was also associated with cerebral infarction. Neurologic complications in adult PCS patients undergoing V-A ECMO support are frequent and associated with higher in-hospital mortality. Identified risk factors of neurologic complications might help to improve ECMO management and might reduce their occurrence.
本研究旨在描述接受静脉-动脉体外膜肺氧合（V-A ECMO）支持的成人心脏术后心源性休克（PCS）患者神经系统并发症的发生率、住院结局以及与此类不良事件相关的因素。415例成年患者接受了心脏手术，并因PCS接受V-A ECMO支持超过24小时。患者被分为两组：发生神经系统并发症的患者和未发生神经系统并发症的患者（对照组）。进行多变量逻辑回归分析以确定与神经系统并发症独立相关的因素。87例患者（21.0%）发生了神经系统并发症，其中33例（8.0%）为脑梗死，30例（7.2%）为脑死亡，14例（3.4%）为癫痫发作，11例（2.7%）为颅内出血。发生神经系统并发症患者的院内死亡率为90.8%，而对照组患者为52.1%（P<0.001）。在多变量模型中，ECMO前最低收缩压（SBP）水平（OR，0.89；95%CI：0.86-0.93）以及主动脉手术联合冠状动脉旁路移植术（OR，9.22；95%CI：2.10-40.55）与总体神经系统并发症相关。年龄（OR，1.06；95%CI：1.01-1.12）和最低SBP（OR，0.81；95%CI：0.76-0.87）是脑死亡的相关因素。凝血障碍（OR，9.75；95%CI：1.83-51.89）和心房颤动（OR，12.19；95%CI：1.22-121.61）被证明与颅内出血独立相关，而心房颤动（OR，8.15；95%CI：1.31-50.62）也与脑梗死相关。接受V-A ECMO支持的成年PCS患者神经系统并发症很常见，且与较高的院内死亡率相关。已确定的神经系统并发症危险因素可能有助于改善ECMO管理并可能减少其发生。
