Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
J Thorac Cardiovasc Surg. 2023 Mar;165(3):1127-1137.e14. doi: 10.1016/j.jtcvs.2022.08.024. Epub 2022 Sep 7.
Extracorporeal membrane oxygenation (ECMO) for postcardiotomy cardiogenic shock has been increasingly used without concomitant mortality reduction. This study aims to investigate determinants of in-hospital and postdischarge mortality in patients requiring postcardiotomy ECMO in the Netherlands.
The Netherlands Heart Registration collects nationwide prospective data from cardiac surgery units. Adults receiving intraoperative or postoperative ECMO included in the register from January 2013 to December 2019 were studied. Survival status was established through the national Personal Records Database. Multivariable logistic regression analyses were used to investigate determinants of in-hospital (3 models) and 12-month postdischarge mortality (4 models). Each model was developed to target specific time points during a patient's clinical course.
Overall, 406 patients (67.2% men, median age, 66.0 years [interquartile range, 55.0-72.0 years]) were included. In-hospital mortality was 51.7%, with death occurring in a median of 5 days (interquartile range, 2-14 days) after surgery. Hospital survivors (n = 196) experienced considerable rates of pulmonary infections, respiratory failure, arrhythmias, and deep sternal wound infections during a hospitalization of median 29 days (interquartile range, 17-51 days). Older age (odds ratio [OR], 1.02; 95% CI, 1.0-1.04) and preoperative higher body mass index (OR, 1.08; 95% CI, 1.02-1.14) were associated with in-hospital death. Within 12 months after discharge, 35.1% of hospital survivors (n = 63) died. Postoperative renal failure (OR, 2.3; 95% CI, 1.6-4.9), respiratory failure (OR, 3.6; 95% CI, 1.3-9.9), and re-thoracotomy (OR, 2.9; 95% CI, 1.3-6.5) were associated with 12-month postdischarge mortality.
In-hospital and postdischarge mortality after postcardiotomy ECMO in adults remains high in the Netherlands. ECMO support in patients with higher age and body mass index, which drive associations with higher in-hospital mortality, should be carefully considered. Further observations suggest that prevention of re-thoracotomies, renal failure, and respiratory failure are targets that may improve postdischarge outcomes.
体外膜肺氧合（ECMO）在心脏手术后心源性休克中的应用越来越多，但死亡率并未降低。本研究旨在调查荷兰心脏手术后接受 ECMO 治疗的患者院内和出院后死亡的决定因素。
荷兰心脏登记处从心脏外科单位收集全国范围的前瞻性数据。从 2013 年 1 月至 2019 年 12 月，登记了术中或术后接受 ECMO 的成年患者。通过全国个人记录数据库确定生存状态。多变量逻辑回归分析用于研究院内（3 个模型）和出院后 12 个月死亡率（4 个模型）的决定因素。每个模型的开发都是针对患者临床过程中的特定时间点。
共纳入 406 例患者（67.2%为男性，中位年龄 66.0 岁[四分位距，55.0-72.0 岁]）。院内死亡率为 51.7%，术后中位死亡时间为 5 天（四分位距，2-14 天）。院内幸存者（n=196）在中位 29 天（四分位距，17-51 天）的住院期间经历了相当高的肺部感染、呼吸衰竭、心律失常和深部胸骨伤口感染发生率。年龄较大（比值比[OR]，1.02；95%置信区间，1.0-1.04）和术前较高的体重指数（OR，1.08；95%置信区间，1.02-1.14）与院内死亡相关。出院后 12 个月内，35.1%的院内幸存者（n=63）死亡。术后肾衰竭（OR，2.3；95%置信区间，1.6-4.9）、呼吸衰竭（OR，3.6；95%置信区间，1.3-9.9）和再次开胸手术（OR，2.9；95%置信区间，1.3-6.5）与出院后 12 个月死亡率相关。
荷兰成人心脏手术后 ECMO 后的院内和出院后死亡率仍然很高。对于年龄较大和体重指数较高的患者，ECMO 支持应谨慎考虑，因为这些因素与较高的院内死亡率相关。进一步的观察表明，预防再次开胸手术、肾衰竭和呼吸衰竭是改善出院后结局的目标。
