Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
J Surg Res. 2024 Jun;298:94-100. doi: 10.1016/j.jss.2024.02.012. Epub 2024 Apr 8.
Extracorporeal membrane oxygenation (ECMO)-associated compartment syndrome (CS) is a rare complication seen in critically ill patients. The epidemiology and management of ECMO-associated CS in the upper extremity (UE) and lower extremity (LE) are poorly defined in the literature. We sought to determine the epidemiology and characterize treatment and outcomes of UE-CS compared to LE-CS in the setting of ECMO therapy.
Adult patients undergoing ECMO therapy were identified in the Nationwide Readmission Database (2015-2019) and followed up for 6 months. Patients were stratified based on UE-CS versus LE-CS. Primary outcomes were fasciotomy and amputation. All-cause mortality and length of stay were also collected. Risk-adjusted modeling was performed to determine patient- and hospital-level factors associated with differences in the management UE-CS versus LE-CS while controlling for confounders.
A total of 24,047 cases of ECMO during hospitalization were identified of which 598 were complicated by CS. Of this population, 507 cases were in the LE (84.8%), while 91 (15.5%) were in the UE. After multivariate analysis, UE-CS patients were less likely to undergo fasciotomy (50.5 vs. 70.9; P = 0.013) and were less likely to undergo amputation of the extremity (3.3 vs. 23.7; P = 0.001) although there was no difference in mortality (58.4 vs. 65.4; P = 0.330).
ECMO patients with CS experience high mortality and morbidity. UE-CS has lower rates of fasciotomy and amputations, compared to LE-CS, with similar mortality. Further studies are needed to elucidate the reasons for these differences.
体外膜肺氧合（ECMO）相关的腔室综合征（CS）是危重病患者中罕见的并发症。在文献中，ECMO 相关 CS 在上肢（UE）和下肢（LE）的流行病学和管理尚不清楚。我们旨在确定 ECMO 治疗中 UE-CS 的流行病学，并与 LE-CS 进行比较，以明确其治疗和结局特征。
在全国再入院数据库（2015-2019 年）中确定接受 ECMO 治疗的成年患者，并进行 6 个月的随访。根据 UE-CS 与 LE-CS 对患者进行分层。主要结局为筋膜切开术和截肢。还收集了全因死亡率和住院时间。进行风险调整建模，以确定在控制混杂因素的情况下，UE-CS 与 LE-CS 管理差异相关的患者和医院水平因素。
共确定了 24047 例住院期间的 ECMO 病例，其中 598 例并发 CS。在此人群中，507 例为 LE（84.8%），91 例为 UE（15.5%）。多变量分析后，UE-CS 患者行筋膜切开术的可能性较小（50.5% vs. 70.9%；P=0.013），肢体截肢的可能性较小（3.3% vs. 23.7%；P=0.001），但死亡率无差异（58.4% vs. 65.4%；P=0.330）。
CS 的 ECMO 患者死亡率和发病率高。与 LE-CS 相比，UE-CS 的筋膜切开术和截肢术发生率较低，死亡率相似。需要进一步的研究来阐明这些差异的原因。
