Nguyen Tung Phi, Phan Xuan Thi, Nguyen Tuan Huu, Huynh Dai Quang, Tran Linh Thanh, Pham Huy Minh, Nguyen Tu Ngoc, Kieu Hieu Trung, Ngoc Pham Thao Thi
Department of Intensive Care, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.
Intensive Care Unit, Vinmec International Hospital, Ho Chi Minh City, Vietnam.
Crit Care Res Pract. 2022 Jan 15;2022:5348835. doi: 10.1155/2022/5348835. eCollection 2022.
Major bleeding has been a common and serious complication with poor outcomes in ECMO patients. With a novel, less-invasive cannulation approach and closer coagulation monitoring regime, the incidence of major bleeding is currently not determined yet. Our study aims to examine the incidence of major bleeding, its determinants, and association with mortality in peripheral-ECMO patients.
We conducted a single-center retrospective study on adult patients undergoing peripheral-ECMO between January 2019 and January 2020 at a tertiary referral hospital. Determinants of major bleeding were defined by logistic regression analysis. Risk factors of in-hospital mortality were determined by Cox proportional hazard regression analysis.
Major bleeding was reported in 33/105 patients (31.4%) and was associated with higher in-hospital mortality [adjusted hazard ratio (aHR) 3.56, 95% confidence interval (CI) 1.63-7.80, < 0.001). There were no significant difference in age, sex, ECMO indications, ECMO modality, pre-ECMO APACHE-II and SOFA scores between two groups with and without major bleeding. Only APTT >72 seconds [adjusted odds ratio (aOR) 7.10, 95% CI 2.60-19.50, < 0.001], fibrinogen <2 g/L [aOR = 7.10, 95% CI 2.60-19.50, < 0.001], and ACT >220 seconds [aOR = 3.9, 95% CI 1.20-11.80, =0.017] on days with major bleeding were independent predictors.
In summary, major bleeding still had a fairly high incidence and poor outcome in peripheral-ECMO patients. APTT > 72 seconds, fibrinogen < 2 g/L were the strongest predicting factors for major bleeding events.
大出血一直是体外膜肺氧合（ECMO）患者常见且严重的并发症，预后较差。采用新型、侵入性较小的插管方法并加强凝血监测后，目前大出血的发生率尚未明确。我们的研究旨在探讨外周ECMO患者大出血的发生率、其决定因素以及与死亡率的关联。
我们在一家三级转诊医院对2019年1月至2020年1月期间接受外周ECMO治疗的成年患者进行了单中心回顾性研究。通过逻辑回归分析确定大出血的决定因素。通过Cox比例风险回归分析确定院内死亡的危险因素。
105例患者中有33例（31.4%）报告发生大出血，且与较高的院内死亡率相关[调整后风险比（aHR）3.56，95%置信区间（CI）1.63 - 7.80，P < 0.001]。有大出血和无大出血的两组患者在年龄、性别、ECMO适应症、ECMO模式、ECMO前急性生理与慢性健康状况评分系统（APACHE-II）和序贯器官衰竭评估（SOFA）评分方面无显著差异。仅大出血当天活化部分凝血活酶时间（APTT）>72秒[调整后比值比（aOR）7.10，95%CI 2.60 - 19.50，P < 0.001]、纤维蛋白原<2 g/L [aOR = 7.10，95%CI 2.60 - 19.50，P < 0.001]以及活化凝血时间（ACT）>220秒[aOR = 3.9，95%CI 1.20 - 11.80，P = 0.017]是独立预测因素。
总之，外周ECMO患者大出血的发生率仍然较高且预后较差。APTT > 72秒、纤维蛋白原<2 g/L是大出血事件的最强预测因素。
