Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Porto, Portugal.
Extracorporeal Life Support Organization, Ann Arbor, MI; Department of Pediatrics (Critical Care), Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
J Cardiothorac Vasc Anesth. 2024 Mar;38(3):731-738. doi: 10.1053/j.jvca.2023.12.027. Epub 2023 Dec 23.
Cardiac tamponade is a potentially life-threatening complication during extracorporeal membrane oxygenation (ECMO). In this study, the authors assessed the incidence, patient characteristics, and risk factors for mortality of cardiac tamponade during ECMO.
The authors queried the Extracorporeal Life Support Organization (ELSO) Registry from 1997 to 2021 for all adults with cardiac tamponade as a reported complication during ECMO.
Cardiac tamponade was reported in 2,176 (64% men; 53.8 ± 0.33 years) of 84,430 adults (2.6%).
Venoarterial ECMO was the main configuration (78%), followed by venovenous ECMO (VV ECMO) (18%), for cardiac (67%), pulmonary (21%) support, and extracorporeal cardiopulmonary resuscitation (ECPR) (12%). Percutaneous cannulation was performed in 51%, with the femoral vein and femoral artery as the most common sites for drainage and return cannulae, with dual-lumen cannulae in 39% of VV ECMO. Hospital survival was lower (35% v 49%; p < 0.01) when compared with that of all adults from the ELSO Registry. In multivariate analysis, age, aortic dissection and/or rupture, COVID-19, ECPR, pre-ECMO renal-replacement therapy, and prone position are associated with hospital mortality, whereas ECMO for pulmonary support is associated with hospital survival. Similarly, renal, cardiovascular, metabolic, neurologic, and pulmonary complications occurred more frequently in nonsurvivors.
Cardiac tamponade is a rare complication during ECMO that, despite being potentially reversible, is associated with high hospital mortality. Venoarterial ECMO is the most common configuration. ECMO for pulmonary support was associated with higher survival, and ECPR was associated with higher mortality. In these patients, other ECMO-related complications were frequently reported and associated with hospital mortality.
心脏压塞是体外膜肺氧合（ECMO）过程中一种潜在危及生命的并发症。本研究评估了 ECMO 期间心脏压塞的发生率、患者特征和死亡率的危险因素。
作者从 1997 年至 2021 年，通过体外生命支持组织（ELSO）注册中心查询了所有 ECMO 期间报告有心脏压塞并发症的成人患者。
84430 名成人患者中报告有 2176 例（64%为男性；53.8±0.33 岁）发生心脏压塞（2.6%）。
静脉-动脉 ECMO 是主要构型（78%），其次是静脉-静脉 ECMO（VV ECMO）（18%），用于心脏（67%）、肺（21%）支持和体外心肺复苏（ECPR）（12%）。51%患者采用经皮插管，最常见的引流和返回插管部位为股静脉和股动脉，39%的 VV ECMO 使用双腔插管。与 ELSO 注册中心的所有成人患者相比，住院存活率较低（35%比 49%；p<0.01）。多变量分析显示，年龄、主动脉夹层和/或破裂、COVID-19、ECPR、ECMO 前肾脏替代治疗和俯卧位与住院死亡率相关，而 ECMO 用于肺支持与住院存活率相关。同样，肾、心血管、代谢、神经和肺部并发症在非幸存者中更常见。
心脏压塞是 ECMO 过程中罕见的并发症，尽管有潜在的可逆性，但与高住院死亡率相关。静脉-动脉 ECMO 是最常见的构型。ECMO 用于肺支持与存活率更高相关，而 ECPR 与死亡率更高相关。在这些患者中，经常报告其他与 ECMO 相关的并发症，并与住院死亡率相关。
