Bünger Victoria, Russ Martin, Kuebler Wolfgang M, Menk Mario, Weber-Carstens Steffen, Graw Jan A
Department of Anesthesiology and Intensive Care Medicine CCM/CVK Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany.
ARDS/ECMO Centrum Charité, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
J Clin Med. 2024 Dec 29;14(1):140. doi: 10.3390/jcm14010140.
Treatment with veno-venous extracorporeal membrane oxygenation (VV ECMO) has become a frequently considered rescue therapy in patients with severe acute respiratory distress syndrome (ARDS). Hemolysis is a common complication in patients treated with ECMO. Currently, it is unclear whether increased ECMO blood flow (Q̇) contributes to mortality and might be associated with increased hemolysis. A total of 441 patients with ARDS and VV ECMO, treated in a tertiary ARDS center, were included. The Q̇ value for a significant increase in ICU mortality was determined by binary recursive partitioning. Linear regression analysis was performed to analyze a correlation between mean Q̇ and mean plasma concentrations of cell-free hemoglobin (CFH). A Q̇ of 4 L/min divided the cohort into two groups with significantly different ICU mortality (Q̇ ≤ 4 L/min: 39.3% ( = 300) versus Q̇ > 4 L/min: 71.6% ( = 141), < 0.001). Patients with Q̇ > 4 L/min had a higher 28-day mortality. Furthermore, a higher mean Q̇ was associated with increased CFH and decreased haptoglobin plasma concentrations. In patients with ARDS and VV ECMO, a mean Q̇ > 4 L/min is associated with increased mortality, increased CFH and decreased haptoglobin plasma concentrations. Whether increased hemolysis determines the poorer outcome associated with higher Q̇ should be the subject of future research.
静脉-静脉体外膜肺氧合（VV ECMO）治疗已成为重症急性呼吸窘迫综合征（ARDS）患者经常被考虑的挽救治疗方法。溶血是接受ECMO治疗患者的常见并发症。目前，尚不清楚增加的ECMO血流量（Q̇）是否会导致死亡率升高，以及是否可能与溶血增加有关。本研究纳入了在一家三级ARDS中心接受治疗的441例ARDS且接受VV ECMO治疗的患者。通过二元递归划分确定ICU死亡率显著增加时的Q̇值。进行线性回归分析以分析平均Q̇与游离血红蛋白（CFH）平均血浆浓度之间的相关性。Q̇为4 L/min时将队列分为两组，其ICU死亡率有显著差异（Q̇≤4 L/min：39.3%（n = 300），而Q̇>4 L/min：71.6%（n = 141），P<0.001）。Q̇>4 L/min的患者28天死亡率更高。此外，较高的平均Q̇与CFH增加和触珠蛋白血浆浓度降低相关。在ARDS且接受VV ECMO治疗的患者中，平均Q̇>4 L/min与死亡率增加、CFH增加和触珠蛋白血浆浓度降低相关。溶血增加是否决定了与较高Q̇相关的较差预后应是未来研究的主题。
