Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Intensive Care Department, Cairo University, Cairo, Egypt.
Int J Artif Organs. 2023 Mar;46(3):153-161. doi: 10.1177/03913988231152978. Epub 2023 Feb 6.
Sepsis could affect the outcomes of patients with postcardiotomy cardiogenic shock supported with extracorporeal membrane oxygenation (ECMO). Our objectives were to characterize sepsis patients with ECMO support for postcardiotomy cardiogenic shock and assess its predictors and effect on patients' outcomes.
This retrospective study included 103 patients with ECMO for postcardiotomy cardiogenic shock from 2009 to 2020. Patients were divided according to the occurrence and timing of sepsis into three groups. Group 1 included patients with no sepsis ( = 67), Group 2 included patients with ECMO-related sepsis ( = 10), and Group 3 included patients with non-ECMO-related sepsis ( = 26).
Lactate level before ECMO was highest in the ECMO-associated sepsis group (Group 1 and 2 = 0.003 and Group 2 and 3 = 0.003). Dialysis and gastrointestinal bleeding were highest in ECMO-associated sepsis ( = 0.03 and 0.04, respectively). Blood transfusion was higher in ECMO-associated sepsis than in patients with no sepsis ( = 0.01). Mortality was nonsignificantly higher in patients with ECMO-associated sepsis. High BMI (OR: 1.11; = 0.004), preoperative dialysis (OR: 7.35; = 0.02), preoperative IABP (OR: 9.9.61; = 0.01) and CABG (OR: 6.29; = 0.01) were significantly associated with sepsis. Older age (OR: 1.08; p = 0.004), lower BSA (OR: 0.004; = 0.003), peripheral cannulation (OR: 29.82; = 0.03), and high pre ECMO lactate level (OR: 1.24; = 0.001) were associated with increased mortality. Sepsis did not predict mortality (OR: 1.83; = 0.21).
Sepsis is a dreaded complication in patients with postcardiotomy cardiogenic shock, especially ECMO-associated sepsis. Preoperative risk factors could predict postoperative sepsis in ECMO patients.
败血症可能会影响体外膜肺氧合（ECMO）支持下心外科手术后心源性休克患者的结局。我们的目标是描述接受 ECMO 支持的心外科手术后心源性休克合并败血症的患者，并评估其预测因素及其对患者结局的影响。
本回顾性研究纳入了 2009 年至 2020 年期间因心外科手术后心源性休克接受 ECMO 治疗的 103 例患者。根据败血症的发生和时间将患者分为三组。第 1 组为无败血症患者（n=67），第 2 组为 ECMO 相关败血症患者（n=10），第 3 组为非 ECMO 相关败血症患者（n=26）。
ECMO 相关败血症组患者的 ECMO 前乳酸水平最高（第 1 组和第 2 组为 0.003，第 2 组和第 3 组为 0.003）。ECMO 相关败血症组患者的透析和胃肠道出血发生率最高（分别为 0.03 和 0.04）。ECMO 相关败血症患者的输血率高于无败血症患者（0.01）。ECMO 相关败血症患者的死亡率虽无显著差异，但略高。较高的 BMI（OR：1.11；p=0.004）、术前透析（OR：7.35；p=0.02）、术前主动脉内球囊反搏（OR：9.96；p=0.01）和冠状动脉旁路移植术（OR：6.29；p=0.01）与败血症显著相关。年龄较大（OR：1.08；p=0.004）、体表面积较小（OR：0.004；p=0.003）、外周置管（OR：29.82；p=0.03）和 ECMO 前乳酸水平较高（OR：1.24；p=0.001）与死亡率增加相关。败血症并不能预测死亡率（OR：1.83；p=0.21）。
败血症是心外科手术后心源性休克患者，尤其是 ECMO 相关败血症患者的一种可怕的并发症。术前危险因素可预测 ECMO 患者术后败血症的发生。
