接受静脉-静脉体外膜肺氧合治疗的急性呼吸衰竭患者，若需要通过静脉-静脉-动脉体外膜肺氧合获得额外循环支持的治疗结果。
Outcomes of patients with acute respiratory failure on veno-venous extracorporeal membrane oxygenation requiring additional circulatory support by veno-venoarterial extracorporeal membrane oxygenation.
作者信息
Erlebach Rolf, Wild Lennart C, Seeliger Benjamin, Rath Ann-Kathrin, Andermatt Rea, Hofmaenner Daniel A, Schewe Jens-Christian, Ganter Christoph C, Müller Mattia, Putensen Christian, Natanov Ruslan, Kühn Christian, Bauersachs Johann, Welte Tobias, Hoeper Marius M, Wendel-Garcia Pedro D, David Sascha, Bode Christian, Stahl Klaus
机构信息
Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
出版信息
Front Med (Lausanne). 2022 Sep 23;9:1000084. doi: 10.3389/fmed.2022.1000084. eCollection 2022.
OBJECTIVE
Veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) is increasingly used to support patients with severe acute respiratory distress syndrome (ARDS). In case of additional cardio-circulatory failure, some experienced centers upgrade the V-V ECMO with an additional arterial return cannula (termed V-VA ECMO). Here we analyzed short- and long-term outcome together with potential predictors of mortality.
DESIGN
Multicenter, retrospective analysis between January 2008 and September 2021.
SETTING
Three tertiary care ECMO centers in Germany (Hannover, Bonn) and Switzerland (Zurich).
PATIENTS
Seventy-three V-V ECMO patients with ARDS and additional acute cardio-circulatory deterioration required an upgrade to V-VA ECMO were included in this study.
MEASUREMENTS AND MAIN RESULTS
Fifty-three patients required an upgrade from V-V to V-VA and 20 patients were directly triple cannulated. Median (Interquartile Range) age was 49 (28-57) years and SOFA score was 14 (12-17) at V-VA ECMO upgrade. Vasoactive-inotropic score decreased from 53 (12-123) at V-VA ECMO upgrade to 9 (3-37) after 24 h of V-VA ECMO support. Weaning from V-VA and V-V ECMO was successful in 47 (64%) and 40 (55%) patients, respectively. Duration of ECMO support was 12 (6-22) days and ICU length of stay was 32 (16-46) days. Overall ICU mortality was 48% and hospital mortality 51%. Two additional patients died after hospital discharge while the remaining patients survived up to two years (with six patients being lost to follow-up). The vast majority of patients was free from higher degree persistent organ dysfunction at follow-up. A SOFA score > 14 and higher lactate concentrations at the day of V-VA upgrade were independent predictors of mortality in the multivariate regression analysis.
CONCLUSION
In this analysis, the use of V-VA ECMO in patients with ARDS and concomitant cardiocirculatory failure was associated with a hospital survival of about 50%, and most of these patients survived up to 2 years. A SOFA score > 14 and elevated lactate levels at the day of V-VA upgrade predict unfavorable outcome.
目的
静脉-静脉（V-V）体外膜肺氧合（ECMO）越来越多地用于支持重症急性呼吸窘迫综合征（ARDS）患者。在出现额外的心循环衰竭时，一些经验丰富的中心会通过增加一根动脉回流插管（称为V-VA ECMO）来升级V-V ECMO。在此，我们分析了短期和长期结局以及死亡的潜在预测因素。
设计
2008年1月至2021年9月期间的多中心回顾性分析。
地点
德国（汉诺威、波恩）和瑞士（苏黎世）的三个三级医疗ECMO中心。
患者
本研究纳入了73例患有ARDS且伴有急性心循环恶化而需要升级为V-VA ECMO的V-V ECMO患者。
测量指标及主要结果
53例患者需要从V-V升级为V-VA，20例患者直接进行了三腔插管。在升级为V-VA ECMO时，中位（四分位间距）年龄为49（28-57）岁，序贯器官衰竭评估（SOFA）评分是14（12-17）。血管活性药物-正性肌力药物评分从升级为V-VA ECMO时的53（12-123）降至V-VA ECMO支持24小时后的9（3-37）。分别有47例（64%）和40例（55%）患者成功撤离V-VA和V-V ECMO。ECMO支持时间为12（6-22）天，重症监护病房（ICU）住院时间为32（16-46）天。总体ICU死亡率为48%，医院死亡率为51%。另外2例患者在出院后死亡，其余患者存活长达两年（6例患者失访）。绝大多数患者在随访时无更严重的持续性器官功能障碍。在多变量回归分析中，V-VA升级当天SOFA评分>14以及乳酸浓度较高是死亡的独立预测因素。
结论
在本分析中，ARDS合并心循环衰竭患者使用V-VA ECMO的医院生存率约为50%，且这些患者中的大多数存活长达2年。V-VA升级当天SOFA评分>14以及乳酸水平升高预示预后不良。
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