Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377 Munich, Germany.
DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart Alliance, Munich, Germany.
Eur Heart J Acute Cardiovasc Care. 2022 Jun 7;11(4):303-311. doi: 10.1093/ehjacc/zuac018.
Intracranial haemorrhage (ICH) is one of the most serious complications of adult patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and is associated with increased morbidity and mortality. However, the prevalence and risk factors of ICH in this cohort are still insufficiently understood. We hypothesized that a considerable proportion of patients undergoing VA-ECMO support suffer from ICH and that specific risk factors are associated with the occurrence of ICH. Therefore, the purpose of this study was to further investigate the prevalence and associated mortality as well as to identify risk factors for ICH in VA-ECMO patients.
We conducted a retrospective multicentre study including adult patients (≥18 years) treated with VA-ECMO in cardiac intensive care units (ICUs) at five German clinical sites between January 2016 and March 2020, excluding patients with ICH upon admission. Differences in baseline characteristics and clinical outcome between VA-ECMO patients with and without ICH were analysed and risk factors for ICH were identified. Among the 598 patients included, 70/598 (12%) developed ICH during VA-ECMO treatment. In-hospital mortality in patients with ICH was 57/70 (81%) and 1-month mortality 60/70 (86%), compared to 332/528 (63%) (P = 0.002) and 340/528 (64%) (P < 0.001), respectively, in patients without ICH. Intracranial haemorrhage was positively associated with diabetes mellitus [odds ratio (OR) 2, 95% confidence interval (CI) 1.11-3.56; P = 0.020] and lactate (per mmol/L) (OR 1.06, 95% CI 1.01-1.11; P = 0.020), and negatively associated with platelet count (per 100 G/L) (OR 0.32, 95% CI 0.15-0.59; P = 0.001) and fibrinogen (per 100 mg/dL) (OR 0.64, 95% CI 0.49-0.83; P < 0.001).
Intracranial haemorrhage was associated with a significantly higher mortality rate. Diabetes mellitus and lactate were positively, platelet count, and fibrinogen level negatively associated with the occurrence of ICH. Thus, platelet count and fibrinogen level were revealed as potentially modifiable, independent risk factors for ICH. The findings address an area with limited data, provide information about risk factors and the epidemiology of ICH, and may be a starting point for further investigations to develop effective strategies to prevent and treat ICH.
颅内出血（ICH）是接受静脉-动脉体外膜肺氧合（VA-ECMO）治疗的成年患者最严重的并发症之一，与发病率和死亡率增加有关。然而，该队列中 ICH 的患病率和危险因素仍了解不足。我们假设相当一部分接受 VA-ECMO 支持的患者患有 ICH，并且特定的危险因素与 ICH 的发生有关。因此，本研究的目的是进一步研究 VA-ECMO 患者 ICH 的患病率和相关死亡率，并确定 ICH 的危险因素。
我们进行了一项回顾性多中心研究，纳入了 2016 年 1 月至 2020 年 3 月期间在德国五个临床中心的心脏重症监护病房（ICU）接受 VA-ECMO 治疗的成年患者（≥18 岁），不包括入院时伴有 ICH 的患者。分析了伴有和不伴有 ICH 的 VA-ECMO 患者的基线特征和临床结局差异，并确定了 ICH 的危险因素。在 598 例患者中，70/598（12%）在 VA-ECMO 治疗期间发生 ICH。ICH 患者的院内死亡率为 57/70（81%）和 1 个月死亡率为 60/70（86%），而无 ICH 患者的院内死亡率为 332/528（63%）（P=0.002）和 340/528（64%）（P<0.001）。颅内出血与糖尿病（优势比[OR]2，95%置信区间[CI]1.11-3.56；P=0.020）和乳酸（每 mmol/L）（OR 1.06，95%CI 1.01-1.11；P=0.020）呈正相关，与血小板计数（每 100 G/L）（OR 0.32，95%CI 0.15-0.59；P=0.001）和纤维蛋白原（每 100 mg/dL）（OR 0.64，95%CI 0.49-0.83；P<0.001）呈负相关。
ICH 与更高的死亡率显著相关。糖尿病和乳酸呈正相关，血小板计数和纤维蛋白原水平呈负相关，与 ICH 的发生有关。因此，血小板计数和纤维蛋白原水平被揭示为潜在可改变的、ICH 的独立危险因素。研究结果涉及一个数据有限的领域，提供了关于 ICH 的危险因素和流行病学的信息，可能是进一步研究以制定预防和治疗 ICH 的有效策略的起点。
