描述脉静脉体外膜肺氧合中低氧血症检测的种族差异：体外生命支持组织登记分析。
Characterizing the Racial Discrepancy in Hypoxemia Detection in Venovenous Extracorporeal Membrane Oxygenation: An Extracorporeal Life Support Organization Registry Analysis.
机构信息
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
出版信息
Lung. 2024 Aug;202(4):471-481. doi: 10.1007/s00408-024-00711-4. Epub 2024 Jun 10.
PURPOSE
Skin pigmentation influences peripheral oxygen saturation (SpO) compared to arterial saturation of oxygen (SaO). Occult hypoxemia (SaO ≤ 88% with SpO ≥ 92%) is associated with increased in-hospital mortality in venovenous-extracorporeal membrane oxygenation (VV-ECMO) patients. We hypothesized VV-ECMO cannulation, in addition to race/ethnicity, accentuates the SpO-SaO discrepancy due to significant hemolysis.
METHODS
Adults (≥ 18 years) supported with VV-ECMO with concurrently measured SpO and SaO measurements from over 500 centers in the Extracorporeal Life Support Organization Registry (1/2018-5/2023) were included. Multivariable logistic regressions were performed to examine whether race/ethnicity was associated with occult hypoxemia in pre-ECMO and on-ECMO SpO-SaO calculations.
RESULTS
Of 13,171 VV-ECMO patients, there were 7772 (59%) White, 2114 (16%) Hispanic, 1777 (14%) Black, and 1508 (11%) Asian patients. The frequency of on-ECMO occult hypoxemia was 2.0% (N = 233). Occult hypoxemia was more common in Black and Hispanic patients versus White patients (3.1% versus 1.7%, P < 0.001 and 2.5% versus 1.7%, P = 0.025, respectively). In multivariable logistic regression, Black patients were at higher risk of pre-ECMO occult hypoxemia versus White patients (adjusted odds ratio [aOR] = 1.55, 95% confidence interval [CI] = 1.18-2.02, P = 0.001). For on-ECMO occult hypoxemia, Black patients (aOR = 1.79, 95% CI = 1.16-2.75, P = 0.008) and Hispanic patients (aOR = 1.71, 95% CI = 1.15-2.55, P = 0.008) had higher risk versus White patients. Higher pump flow rates (aOR = 1.29, 95% CI = 1.08-1.55, P = 0.005) and on-ECMO 24-h lactate (aOR = 1.06, 95% CI = 1.03-1.10, P < 0.001) significantly increased the risk of on-ECMO occult hypoxemia.
CONCLUSION
SaO should be carefully monitored if using SpO during ECMO support for Black and Hispanic patients especially for those with high pump flow and lactate values at risk for occult hypoxemia.
目的
与动脉血氧饱和度 (SaO) 相比，皮肤色素沉着会影响外周血氧饱和度 (SpO)。隐匿性低氧血症（SaO≤88%，SpO≥92%）与静脉-静脉体外膜肺氧合 (VV-ECMO) 患者住院死亡率增加有关。我们假设 VV-ECMO 置管术，除了种族/民族之外，由于严重的溶血，会加剧 SpO-SaO 差异。
方法
纳入了来自体外生命支持组织注册中心（1/2018-5/2023）500 多个中心同时测量 SpO 和 SaO 的 VV-ECMO 患者（≥18 岁）。进行多变量逻辑回归分析，以检查种族/民族是否与 ECMO 前和 ECMO 期间的 SpO-SaO 计算中的隐匿性低氧血症相关。
结果
在 13171 例 VV-ECMO 患者中，白人患者 7772 例（59%），西班牙裔患者 2114 例（16%），黑种人患者 1777 例（14%），亚洲患者 1508 例（11%）。ECMO 期间隐匿性低氧血症的发生率为 2.0%（N=233）。黑人患者和西班牙裔患者比白人患者更易发生隐匿性低氧血症（3.1%比 1.7%，P<0.001 和 2.5%比 1.7%，P=0.025）。在多变量逻辑回归中，黑人患者发生 ECMO 前隐匿性低氧血症的风险高于白人患者（调整后的优势比[aOR] = 1.55，95%置信区间[CI] = 1.18-2.02，P=0.001）。对于 ECMO 期间的隐匿性低氧血症，黑人患者（aOR=1.79，95%CI=1.16-2.75，P=0.008）和西班牙裔患者（aOR=1.71，95%CI=1.15-2.55，P=0.008）发生隐匿性低氧血症的风险高于白人患者。更高的泵流速（aOR=1.29，95%CI=1.08-1.55，P=0.005）和 ECMO 24 小时乳酸（aOR=1.06，95%CI=1.03-1.10，P<0.001）显著增加了 ECMO 期间隐匿性低氧血症的风险。
结论
如果在 ECMO 支持期间使用 SpO，特别是对于那些泵流速较高且乳酸值较高的黑人患者和西班牙裔患者，应仔细监测 SaO，以避免隐匿性低氧血症。
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