Kakuturu Jahnavi, Dhamija Ankit, Chan Ernest, Lagazzi Luigi, Thibault Dylan, Badhwar Vinay, Hayanga J W A
Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA.
Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Perfusion. 2023 Oct;38(7):1468-1477. doi: 10.1177/02676591221117355. Epub 2022 Aug 5.
Extracorporeal membrane oxygenation (ECMO) has been used increasingly for cardiopulmonary rescue. Despite recent advances however, post-cardiotomy shock (PCS)-ECMO survival remains comparatively poor. We sought to evaluate outcomes and define factors that predict in-hospital mortality.
We used the Nationwide Inpatient Sample (NIS) to evaluate adult hospitalizations with a primary procedure code for coronary artery bypass grafting (CABG), and/or valve procedures performed between 2013 and 2018, which also required post cardiotomy ECMO support. Patient-related factors and hospital costs were evaluated to identify those associated with in-hospital mortality.
There were 1,247,835 admissions for cardiac surgical procedures during the study period. Post-cardiotomy shock-ECMO support was provided in 4475 (0.3%) within the study cohort. A total of 2000 (44.7%) hospitalizations involved isolated valvular procedures, 1700 (38.0%) isolated CABG, and 775 (17.3%) involved a combination of both. Overall, in-hospital mortality was 42.1% ( = 1880). Factors significantly associated with in-hospital mortality included patients with multiple comorbidities (> 7) and those undergoing combination of valve and CABG procedures. Only 26.6% of those who survived to discharge, were discharged home independently.
Survival to independent home discharge is rare following PCS-ECMO. Its high mortality is associated with multiple comorbidities and combination of CABG and valve surgery.
体外膜肺氧合（ECMO）已越来越多地用于心肺抢救。然而，尽管最近取得了进展，但心脏术后休克（PCS）-ECMO患者的生存率仍然相对较低。我们试图评估预后情况并确定预测住院死亡率的因素。
我们使用全国住院患者样本（NIS）来评估2013年至2018年间进行冠状动脉搭桥术（CABG）和/或瓣膜手术的主要手术编码的成年住院患者，这些患者术后也需要ECMO支持。评估患者相关因素和医院费用，以确定与住院死亡率相关的因素。
在研究期间，有1247835例患者接受了心脏外科手术。研究队列中有4475例（0.3%）患者接受了心脏术后休克-ECMO支持。共有2000例（44.7%）住院患者仅接受瓣膜手术，1700例（38.0%）仅接受CABG，775例（17.3%）接受了两者联合手术。总体而言，住院死亡率为42.1%（n = 1880）。与住院死亡率显著相关的因素包括患有多种合并症（>7种）的患者以及接受瓣膜手术和CABG联合手术的患者。存活至出院的患者中，只有26.6%能够独立出院回家。
PCS-ECMO后存活至独立出院回家的情况很少见。其高死亡率与多种合并症以及CABG和瓣膜手术联合有关。
