From the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Neuroscience Critical Care, Departments of Neurology and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
ASAIO J. 2023 Aug 1;69(8):795-801. doi: 10.1097/MAT.0000000000001969. Epub 2023 May 12.
Our primary objective was to identify if fasciotomy was associated with increased mortality in patients who developed acute compartment syndrome (ACS) on extracorporeal cardiopulmonary resuscitation (ECPR). Additionally, we sought to identify any additional risk factors for mortality in these patients and report the amputation-free survival following fasciotomy. We retrospectively reviewed adult ECPR patients from the Extracorporeal Life Support Organization registry who were diagnosed with ACS between 2013 and 2021. Of 764 ECPR patients with limb complications, 127 patients (17%) with ACS were identified, of which 78 (63%) had fasciotomies, and 14 (11%) had amputations. Fasciotomy was associated with a 23% rate of amputation-free survival. There were no significant differences in demographics or baseline laboratory values between those with and without fasciotomy. Overall, 88 of 127 (69%) patients with ACS died. With or without fasciotomy, the mortality of ACS patients was similar, 68% vs. 71%. Multivariable logistic regression demonstrated that body mass index (BMI; adjusted odds ratio [aOR] = 1.22, 95% confidence interval [CI] = 1.01-1.48) and 24 hour mean blood pressure (BP; aOR = 0.93, 95% CI = 0.88-0.99) were independently associated with mortality. Fasciotomy was not an independent risk factor for mortality (aOR = 0.24, 95% CI = 0.03-1.88). The results of this study may help guide surgical decision-making for patients who develop ACS after ECPR. However, the retrospective nature of this study does not preclude selection bias in patients who have received fasciotomy. Thus, prospective studies are necessary to confirm these findings.
我们的主要目的是确定在接受体外心肺复苏（ECPR）的患者中发生急性间隔综合征（ACS）时，筋膜切开术是否与死亡率增加有关。此外，我们还试图确定这些患者死亡的其他危险因素，并报告筋膜切开术后的无截肢生存率。我们回顾性分析了 2013 年至 2021 年期间在体外生命支持组织登记处接受 ECPR 的成人患者，这些患者被诊断为 ACS。在 764 例有肢体并发症的 ECPR 患者中，有 127 例（17%）被诊断为 ACS，其中 78 例（63%）接受了筋膜切开术，14 例（11%）接受了截肢术。筋膜切开术与 23%的无截肢生存率相关。在接受或不接受筋膜切开术的患者之间，人口统计学或基线实验室值没有显著差异。总的来说，127 例 ACS 患者中有 88 例（69%）死亡。无论是否进行筋膜切开术，ACS 患者的死亡率相似，分别为 68%和 71%。多变量逻辑回归表明，体重指数（BMI；调整后的优势比[aOR]=1.22，95%置信区间[CI]=1.01-1.48）和 24 小时平均血压（BP；aOR=0.93，95%CI=0.88-0.99）与死亡率独立相关。筋膜切开术不是死亡率的独立危险因素（aOR=0.24，95%CI=0.03-1.88）。本研究的结果可能有助于指导接受 ECPR 后发生 ACS 的患者的手术决策。然而，这项研究的回顾性性质并不能排除接受筋膜切开术的患者存在选择偏倚。因此，需要前瞻性研究来证实这些发现。
