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体外膜肺氧合转运计划:我们目前学到了什么。

ECMO Retrieval Program: What Have We Learned So Far.

作者信息

Krasivskyi Ihor, Großmann Clara, Dechow Marit, Djordjevic Ilija, Ivanov Borko, Gerfer Stephen, Bennour Walid, Kuhn Elmar, Sabashnikov Anton, Mader Navid, Eghbalzadeh Kaveh, Wahlers Thorsten

机构信息

Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany.

Department of Cardiothoracic Surgery, Helios Hospital Siegburg, Heart Centre, 53721 Siegburg, Germany.

出版信息

Life (Basel). 2023 Jan 5;13(1):157. doi: 10.3390/life13010157.

Abstract

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for patients with cardiogenic shock or cardiac arrest. However, survival rates remain low. It is unclear to what extent ECMO patients benefit from the ECMO team learning curve. Therefore, we aimed to analyze our mobile ECMO program patients from the past seven years to evaluate if a learning curve benefits patients’ outcomes. We analyzed 111 patients from our databank who were supported with a VA-ECMO and brought to our hospital from January 2015 to December 2021. Patients were divided into two groups: survival (n = 70) and non-survival (n = 41). As expected, complications after ECMO implantation were more severe in the non-survivor group. The incidence of thromboembolic events (p = 0.002), hepatic failure (p < 0.001), renal failure (p = 0.002), dialysis (p = 0.002) and systemic inflammatory response syndrome (SIRS, p = 0.044) occurred significantly more often compared with the survivor group. We were able to show that despite our extensive experience in terms of ECMO retrieval program the high mortality and morbidity rates stay fairly the same over the years. This displays that we have to focus even more on patient selection and ECMO indication.

摘要

静脉-动脉体外膜肺氧合(VA-ECMO)越来越多地用于心源性休克或心脏骤停患者。然而,生存率仍然很低。目前尚不清楚ECMO患者在多大程度上受益于ECMO团队的学习曲线。因此,我们旨在分析过去七年中我们的移动ECMO项目患者,以评估学习曲线是否对患者的预后有益。我们分析了数据库中2015年1月至2021年12月期间接受VA-ECMO支持并被送往我院的111例患者。患者分为两组:存活组(n = 70)和非存活组(n = 41)。正如预期的那样,非存活组ECMO植入后的并发症更为严重。与存活组相比,血栓栓塞事件(p = 0.002)、肝功能衰竭(p < 0.001)、肾功能衰竭(p = 0.002)、透析(p = 0.002)和全身炎症反应综合征(SIRS,p = 0.044)的发生率明显更高。我们能够证明,尽管我们在ECMO回收项目方面有丰富经验,但多年来高死亡率和发病率仍相当稳定。这表明我们必须更加关注患者选择和ECMO适应症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73d6/9865097/8abdd7659eec/life-13-00157-g001.jpg

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