From the Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center.
Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
ASAIO J. 2023 Apr 1;69(4):352-359. doi: 10.1097/MAT.0000000000001813. Epub 2022 Oct 25.
We applied the Society for Cardiovascular Angiography and Interventions (SCAI) schema to cardiogenic shock (CS) patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) to assess performance in this high acuity group of patients. Records of adult patients receiving VA-ECMO for CS at our institution from 01/2015 to 12/2019 were reviewed. Post-cardiotomy and noncardiogenic shock patients were excluded. A total of 245 patients were included, with a median age of 59 years [IQR: 48-67]; 159 (65%) were male. There were 34 (14%) patients in Stage C, 82 (33%) in D, and 129 (53%) in E. Of E patients, 88 (68%) were undergoing cardiopulmonary resuscitation. Median ECMO duration decreased with stage (C:7, D:6, E:4 days, P < 0.001). In-hospital mortality increased (C:35%, D:56%, E:71%, P < 0.001) and myocardial recovery decreased with stage (C:65%, D:35%, E:30%, P < 0.001). Acute kidney injury (C:35%, D:45%, E:54%, P = 0.045), acute liver failure (C:32%, D:66%, E:76%, P < 0.001), and infection (C:35%, D:28%, E:16%, P = 0.004) varied among groups. Multivariable analysis revealed age (HR=1.02), male sex (HR=0.62), and E classification (HR=2.69) as independently associated with 1-year mortality. Competing-risks regression identified D (SHR=0.53) and E classification (SHR=0.45) as inversely associated with myocardial recovery. In patients treated with VA-ECMO for CS, the SCAI classification provided robust risk stratification.
我们将心血管血管造影和介入学会 (SCAI) 方案应用于接受静脉动脉体外膜肺氧合 (VA-ECMO) 治疗的心源性休克 (CS) 患者，以评估该高敏组患者的表现。回顾了我院自 2015 年 1 月至 2019 年 12 月期间接受 VA-ECMO 治疗 CS 的成年患者的记录。排除了心脏手术后和非心源性休克患者。共纳入 245 例患者，中位年龄 59 岁[IQR：48-67]；159 例（65%）为男性。有 34 例（14%）患者为 C 期，82 例（33%）为 D 期，129 例（53%）为 E 期。E 期患者中有 88 例（68%）正在进行心肺复苏。随着分期的进展，ECMO 持续时间中位数降低（C 期：7 天，D 期：6 天，E 期：4 天，P < 0.001）。住院死亡率增加（C 期：35%，D 期：56%，E 期：71%，P < 0.001），心功能恢复率随分期下降（C 期：65%，D 期：35%，E 期：30%，P < 0.001）。急性肾损伤（C 期：35%，D 期：45%，E 期：54%，P = 0.045）、急性肝功能衰竭（C 期：32%，D 期：66%，E 期：76%，P < 0.001）和感染（C 期：35%，D 期：28%，E 期：16%，P = 0.004）在各组之间存在差异。多变量分析显示年龄（HR=1.02）、男性（HR=0.62）和 E 分类（HR=2.69）与 1 年死亡率独立相关。竞争风险回归确定 D 期（SHR=0.53）和 E 分类（SHR=0.45）与心肌恢复呈负相关。在接受 VA-ECMO 治疗 CS 的患者中，SCAI 分类提供了强大的风险分层。
