Dragulescu Razvan, Armoiry Xavier, Jacquet-Lagrèze Matthias, Portran Philippe, Schweizer Remi, Fellahi Jean Luc, Grinberg Daniel, Obadia Jean Francois, Pozzi Matteo
Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France.
University of Lyon, School of Pharmacy (ISPB)/UMR CNRS 5510 MATEIS/"Edouard Herriot" Hospital, Pharmacy Department, Lyon, France.
J Cardiothorac Vasc Anesth. 2023 Nov;37(11):2272-2279. doi: 10.1053/j.jvca.2023.07.025. Epub 2023 Jul 24.
To analyze the incidence, clinical impact on survival, and risk factors of lower limb ischemia (LLI) of surgical peripheral femoral venoarterial extracorporeal membrane oxygenation (VA ECMO) in the current era.
A retrospective analysis of the authors' institutional database of VA ECMO was performed. Patients were divided into 2 groups according to the occurrence of LLI. The primary endpoint was survival to hospital discharge. Risk factors of LLI were searched with multivariate analyses.
University hospital.
Adult patients receiving peripheral VA ECMO for refractory cardiogenic shock and cardiac arrest.
None.
From January 2018 to December 2021, 188 patients (mean age: 52.0 ± 14.1 years; 63.8% male, 36.2% female) received peripheral VA ECMO. Male sex was more prevalent in the group without LLI (65.9% v 33.3%; p = 0.031). Twelve (6.4%) patients developed LLI during VA ECMO support (n = 6) or after VA ECMO removal (n = 6). Survival to hospital discharge was not statistically different between patients with and without LLI (50.0% v 48.3%; p = 0.571). Female sex patients were at increased risk for LLI (odds ratio 4.38, 95% CI 1.21-15.81; p = 0.024).
Peripheral femoral VA ECMO through a surgical approach is associated with a low LLI rate, which does not increase the risk of in-hospital mortality. The female sex is an independent risk factor for LLI.
分析当前时代外科外周股静脉 - 动脉体外膜肺氧合（VA ECMO）下肢缺血（LLI）的发生率、对生存的临床影响及危险因素。
对作者所在机构的VA ECMO数据库进行回顾性分析。根据LLI的发生情况将患者分为两组。主要终点是出院生存率。通过多因素分析寻找LLI的危险因素。
大学医院。
因难治性心源性休克和心脏骤停接受外周VA ECMO的成年患者。
无。
2018年1月至2021年12月，188例患者（平均年龄：52.0±14.1岁；男性63.8%，女性36.2%）接受外周VA ECMO。无LLI组男性更常见（65.9%对33.3%；p = 0.031）。12例（6.4%）患者在VA ECMO支持期间（n = 6）或VA ECMO撤除后（n = 6）发生LLI。有LLI和无LLI患者的出院生存率无统计学差异（50.0%对48.3%；p = 0.571）。女性患者发生LLI的风险增加（比值比4.38，95%可信区间1.21 - 15.81；p = 0.024）。
通过外科手术途径的外周股静脉VA ECMO与低LLI发生率相关，且不增加住院死亡率风险。女性是LLI的独立危险因素。
