Sahli Sebastian D, Kaserer Alexander, Braun Julia, Halbe Maximilian, Dahlem Yuliya, Spahn Muriel A, Rössler Julian, Krüger Bernard, Maisano Francesco, Spahn Donat R, Wilhelm Markus J
Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
Departments of Biostatistics and Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
J Thorac Dis. 2022 Jun;14(6):1960-1971. doi: 10.21037/jtd-21-1770.
Extracorporeal life support (ECLS) therapy is increasingly used for cardiac and respiratory support postcardiotomy, refractory cardiogenic shock and cardiopulmonary resuscitation. This study aims to describe in-hospital mortality of patients requiring ECLS, identify independent predictors associated with mortality and analyze changes of mortality over time.
This retrospective study includes all adult ECLS cases at the University Hospital Zurich, a designated ECLS center in Switzerland, in the period 2007 to 2019.
ECLS therapy was required in 679 patients (median age 60 years, 27.5% female). In-hospital mortality was 55.5%. Cubic spline interpolation did not detect evidence for a change in mortality over the whole period of 13 years. In-hospital mortality significantly varied between ECLS indications: 70.7% (152/215) for postcardiotomy, 67.9% (108/159) for cardiopulmonary resuscitation, 47.0% (110/234) for refractory cardiogenic shock, and 9.9% (7/71) for lung transplantation and expansive thoracic surgery (P<0.001). Logistic regression modelling showed excellent discrimination in the receiver operating characteristic (ROC) area under the curve (AUC) of 0.89 [95% confidence interval (CI): 0.87-0.92] and identified significant mortality predictors: age, simplified acute physiology score (SAPS) II, as well as new liver failure and each allogenic blood transfusion unit given per day. ECLS after cardiopulmonary resuscitation was associated with significantly higher mortality compared to ECLS for refractory cardiogenic shock.
In-hospital mortality of patients treated with ECLS therapy is high. Outcomes have not changed significantly in the observed period. We identified age, SAPS II, new liver failure and each allogenic blood transfusion unit given per day as independent mortality predictors. Knowledge of predictors strongly associated with in-hospital mortality may affect future decisions about ECLS indications and the respective management to use this elaborate therapy more effectively.
体外生命支持（ECLS）疗法越来越多地用于心脏手术后的心脏和呼吸支持、难治性心源性休克及心肺复苏。本研究旨在描述需要ECLS治疗的患者的院内死亡率，确定与死亡率相关的独立预测因素，并分析死亡率随时间的变化。
这项回顾性研究纳入了瑞士指定的ECLS中心苏黎世大学医院2007年至2019年期间所有的成人ECLS病例。
679例患者需要ECLS治疗（中位年龄60岁，27.5%为女性）。院内死亡率为55.5%。三次样条插值法未发现整个13年期间死亡率有变化的证据。不同ECLS适应证的院内死亡率有显著差异：心脏手术后为70.7%（152/215），心肺复苏后为67.9%（108/159），难治性心源性休克为47.0%（110/234），肺移植和扩大胸廓手术后为9.9%（7/71）（P<0.001）。逻辑回归模型在曲线下接受者操作特征（ROC）面积（AUC）为0.89 [95%置信区间（CI）：0.87 - 0.92]时显示出良好的区分能力，并确定了显著的死亡率预测因素：年龄、简化急性生理学评分（SAPS）II，以及新发肝衰竭和每天输注的异体输血单位数。与难治性心源性休克的ECLS相比，心肺复苏后的ECLS与显著更高的死亡率相关。
接受ECLS治疗的患者院内死亡率较高。在观察期内结果没有显著变化。我们确定年龄、SAPS II、新发肝衰竭和每天输注的异体输血单位数为独立的死亡率预测因素。了解与院内死亡率密切相关的预测因素可能会影响未来关于ECLS适应证的决策以及各自的管理，以便更有效地使用这种复杂的治疗方法。
