体外膜肺氧合后的长期生存和生活质量。
Long-term survival and quality of life after extracorporeal membrane oxygenation.
机构信息
Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada.
Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada.
出版信息
J Thorac Cardiovasc Surg. 2023 Aug;166(2):555-566.e2. doi: 10.1016/j.jtcvs.2021.10.077. Epub 2022 Feb 18.
OBJECTIVES
Long-term data on patient survivors after extracorporeal membrane oxygenation (ECMO) support remains limited. This study sought to examine the 5-year survival and health-related quality of life (HRQoL) of patients treated with venoarterial (VA)- or venovenous (VV)-ECMO.
METHODS
A single-center retrospective chart review and survival analysis was conducted on all patients who required ECMO from December 2007 to June 2019. Cross-sectional HRQoL assessments were performed using 8 standardized questionnaires among survivors.
RESULTS
Records for 370 ECMO patients (288 VA-ECMO, 82 VV-ECMO) were reviewed. Survival at 5 years was 33% (VA-ECMO) and 36% (VV-ECMO). Among patients that survived to 30 days, 5-year survival rates were 73% (VA-ECMO) and 71% (VV-ECMO). Sixty surviving patients (56%) had HRQoL assessments (48 VA-ECMO, 12 VV-ECMO). Median follow-up time was 4.2 (VA-ECMO) and 5.7 years (VV-ECMO). Fourteen (29%) VA-ECMO patients and 9 (75%) VV-ECMO patients reported difficulty with any activity of daily living whereas 13 (27%) VA-ECMO patients and 8 (67%) VV-ECMO patients reported difficulty with any instrumental activity of daily living. Eleven (23%) VA-ECMO patients and 7 (58%) VV-ECMO patients reported a high post-traumatic stress disorder score. Low decision regret scores in both cohorts indicated minimal regret that ECMO was initiated.
CONCLUSIONS
Five-year clinical and patient-centered outcomes of patients requiring ECMO support is acceptable in those who survived the initial 30 days. Among ECMO survivors, persistent HRQoL concerns were apparent, highlighting the importance of longer-term postdischarge follow-up.
目的
体外膜肺氧合（ECMO）支持后患者幸存者的长期数据仍然有限。本研究旨在检查接受静脉-动脉（VA）-或静脉-静脉（VV）-ECMO 治疗的患者的 5 年生存率和健康相关生活质量（HRQoL）。
方法
对 2007 年 12 月至 2019 年 6 月期间因 ECMO 而需要 ECMO 的所有患者进行了单中心回顾性图表审查和生存分析。在幸存者中使用 8 种标准化问卷进行了横断面 HRQoL 评估。
结果
共回顾了 370 例 ECMO 患者（288 例 VA-ECMO，82 例 VV-ECMO）的记录。5 年生存率为 33%（VA-ECMO）和 36%（VV-ECMO）。在存活至 30 天的患者中，5 年生存率分别为 73%（VA-ECMO）和 71%（VV-ECMO）。60 名幸存患者（56%）进行了 HRQoL 评估（48 例 VA-ECMO，12 例 VV-ECMO）。中位随访时间分别为 VA-ECMO 为 4.2 年和 VV-ECMO 为 5.7 年。14 例（29%）VA-ECMO 患者和 9 例（75%）VV-ECMO 患者报告在任何日常生活活动中存在困难，而 13 例（27%）VA-ECMO 患者和 8 例（67%）VV-ECMO 患者报告在任何工具性日常生活活动中存在困难。11 例（23%）VA-ECMO 患者和 7 例（58%）VV-ECMO 患者报告 PTSD 评分较高。两组患者的决策后悔评分均较低，表明对启动 ECMO 的后悔程度较小。
结论
在最初 30 天存活的患者中，需要 ECMO 支持的患者的 5 年临床和以患者为中心的结果是可以接受的。在 ECMO 幸存者中，明显存在持续的 HRQoL 问题，这突出了出院后长期随访的重要性。
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