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在接受体外膜肺氧合(VA-ECMO)治疗的院外心脏骤停患者中,弥散性血管内凝血与不良预后相关。

Disseminated intravascular coagulation is associated with a poor outcome in patients with out-of-hospital cardiac arrest receiving VA-ECMO.

作者信息

Gando Satoshi, Tsuchida Takumi, Wada Takeshi

机构信息

Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan.

Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.

出版信息

J Artif Organs. 2025 Jan 6. doi: 10.1007/s10047-024-01487-3.

Abstract

We tested the hypothesis that disseminated intravascular coagulation (DIC) predicts a poor prognosis in patients with out-of-hospital cardiac arrest (OHCA) treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Fifty-seven patients with cardiogenic OHCA who immediately underwent VA-ECMO upon admission to the emergency department were divided into 27 non-DIC and 30 DIC patients. DIC scores were calculated on admission and 24 h later (day 1). The primary outcome measure was the all-cause in-hospital mortality. The basic characteristics did not differ between the two groups; however, patients with DIC showed higher in-hospital mortality rates. Receiver operating characteristic curve analysis showed a moderate predictive ability of DIC scores on day 1 for in-hospital mortality. A lower probability of survival was observed in patients with DIC. The adjusted odds ratio for DIC on day 1 of in-hospital death was 5.67, confirmed by the adjusted hazard ratio of 3.472. The results indicate an association between DIC diagnosis 24 h following VA-ECMO induction for OHCA and poor outcome in these patients.

摘要

我们检验了以下假设

弥散性血管内凝血(DIC)预示着接受静脉-动脉体外膜肺氧合(VA-ECMO)治疗的院外心脏骤停(OHCA)患者预后不良。57例心源性OHCA患者在急诊科入院后立即接受VA-ECMO治疗,分为27例非DIC患者和30例DIC患者。入院时和24小时后(第1天)计算DIC评分。主要结局指标是全因院内死亡率。两组患者的基本特征无差异;然而,DIC患者的院内死亡率较高。受试者工作特征曲线分析显示,第1天的DIC评分对院内死亡率具有中等预测能力。DIC患者的生存概率较低。院内死亡第1天DIC的校正比值比为5.67,校正风险比为3.472证实了这一点。结果表明,OHCA患者在VA-ECMO启动后24小时诊断出DIC与这些患者的不良结局之间存在关联。

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