Division of Cardiac Surgery, Department of Surgery, 6923University of Rochester Medical Center, Rochester, NY, USA.
Department of Anesthesiology and Perioperative Medicine, 6923University of Rochester Medical Center, Rochester, NY, USA.
J Intensive Care Med. 2022 Dec;37(12):1545-1552. doi: 10.1177/08850666221086839. Epub 2022 Mar 14.
A survival gap between weaning from venoarterial-extracorporeal membrane oxygenation (VA-ECMO) and the hospital discharge has been consistently reported. The aim of this study is to investigate the clinical features of patients who underwent successful VA-ECMO decannulation at our institution and to identify the major contributors responsible for adverse outcomes.
We retrospectively reviewed all patients supported with VA-ECMO in our institution between January 2013 and June 2020. Only patients that survived VA-ECMO and underwent successful decannulation were included and dichotomized based on survival to hospital discharge: non-survivors versus survivors. The primary study outcome was the cause of death after successful VA-ECMO decannulation.
Of the 262 adult patients who underwent VA-ECMO decannulation, 72 (27.5%) patients did not survive to hospital discharge. Non-survivors were older (62 vs. 54 years, p < 0.001) and suffering from many pre-existing comorbidities. Pneumonia and sepsis were the most frequent infectious complication and almost twice as likely in non-survivors. Major causes of death were: cardiovascular (31.9%), infections (25.0%) and neurological (20.8%). The survival curve demonstrated that 51.4% of our patients died within 8 days after decannulation. Multivariate analysis identified older age, central venous cannulation, pulmonary bleeding and infection, dialysis after VA-ECMO, sepsis, and ischemic stroke (OR = 7.86, 95% CI: 2.76-2.43, p < 0.001) as factors significantly predisposing to patients' death.
In our study, one-third of patients decannulated off VA-ECMO did not survive to hospital discharge due to end-stage heart failure, infections or neurological injury. The first 8 post-decannulation days were recognized as a critical period where thorough strategies to prevent acquired infections and cautious support of end-organ function should be warranted. Future large-scale trials are needed to confirm our results.
从体外膜肺氧合（VA-ECMO）撤机到出院之间存在生存差距，这一现象已被反复报道。本研究旨在探讨我院成功撤机患者的临床特征，并确定导致不良结局的主要因素。
我们回顾性分析了我院 2013 年 1 月至 2020 年 6 月期间接受 VA-ECMO 支持的所有患者。仅纳入成功撤机并存活至出院的患者，并根据是否存活至出院分为两组：死亡组和存活组。主要研究终点为成功撤机后死亡的原因。
在 262 例接受 VA-ECMO 撤机的成年患者中，72 例（27.5%）患者未存活至出院。死亡组患者年龄更大（62 岁 vs. 54 岁，p<0.001），且合并多种基础疾病。肺炎和脓毒症是最常见的感染并发症，且在死亡组中更为常见（约为存活组的两倍）。主要死亡原因为心血管疾病（31.9%）、感染（25.0%）和神经系统疾病（20.8%）。生存曲线显示，51.4%的患者在撤机后 8 天内死亡。多因素分析发现，年龄较大、中心静脉置管、肺出血、感染、VA-ECMO 后行透析、脓毒症和缺血性卒中（OR=7.86，95%CI：2.76-2.43，p<0.001）是导致患者死亡的显著危险因素。
在本研究中，三分之一的患者因终末期心力衰竭、感染或神经损伤而无法存活至出院。撤机后前 8 天被认为是一个关键时期，在此期间应采取全面的预防获得性感染策略，并谨慎支持终末器官功能。需要进行大规模的临床试验来验证我们的研究结果。
