Zhu Yi, Mao Lina, Zhang Zhongman, Lee Sae Rom, Li Tianshi, Zhou Hao, Dong Yanbin, An Di, Li Wei, Chen Xufeng
Department of Emergency and Critical Care Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China.
Department of Emergency Center, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China.
World J Emerg Med. 2025;16(2):153-160. doi: 10.5847/wjem.j.1920-8642.2025.037.
Intracranial hemorrhage (ICH), a severe complication among adults receiving extracorporeal membrane oxygenation (ECMO), is often related to poor outcomes. This study aimed to establish a predictive model for ICH in adults receiving ECMO treatment.
Adults who received ECMO between January 2017 and June 2022 were the subjects of a single-center retrospective study. Patients under the age of 18 years old, with acute ICH before ECMO, with less than 24 h of ECMO support, and with incomplete data were excluded. ICH was diagnosed by a head computed tomography scan. The outcomes included the incidence of ICH, in-hosptial mortality and 28-day mortality. Multivariate logistic regression analysis was used to identify relevant risk factors of ICH, and a predictive model of ICH with a nomogram was constructed.
Among the 227 patients included, 22 developed ICH during ECMO. Patients with ICH had higher in-hospital mortality (90.9% vs. 47.8%, =0.001) and higher 28-day mortality (81.8% vs. 47.3%, =0.001) than patients with non-ICH. ICH was associated with decreased grey-white-matter ratio (GWR) (=0.894, 95%: 0.841-0.951, <0.001), stroke history (=4.265, 95%: 1.052-17.291, =0.042), fresh frozen plasma (FFP) transfusion (=1.208, 95%: 1.037-1.408, =0.015) and minimum platelet (PLT) count during ECMO support (=0.977, 95%: 0.958-0.996, =0.019). The area under the receiver operating characteristic curve of the ICH predictive model was 0.843 (95%: 0.762-0.924, <0.001).
ECMO-treated patients with ICH had a higher risk of death. GWR, stroke history, FFP transfusion, and the minimum PLT count were independently associated with ICH, and the ICH predictive model showed that these parameters performed well as diagnostic tools.
颅内出血（ICH）是接受体外膜肺氧合（ECMO）治疗的成年人中的一种严重并发症，常与不良预后相关。本研究旨在建立接受ECMO治疗的成年人颅内出血的预测模型。
对2017年1月至2022年6月期间接受ECMO治疗的成年人进行单中心回顾性研究。排除18岁以下、ECMO治疗前有急性ICH、ECMO支持时间少于24小时以及数据不完整的患者。通过头部计算机断层扫描诊断ICH。结局指标包括ICH的发生率、住院死亡率和28天死亡率。采用多因素逻辑回归分析确定ICH的相关危险因素，并构建带有列线图的ICH预测模型。
在纳入的227例患者中，22例在ECMO治疗期间发生ICH。与未发生ICH的患者相比，发生ICH的患者住院死亡率更高（90.9%对47.8%，P=0.001），28天死亡率更高（81.8%对47.3%，P=0.001）。ICH与灰白质比率（GWR）降低相关（P=0.894，95%CI：0.841-0.951，P<0.001）、有卒中病史（P=4.265，95%CI：1.052-17.291，P=0.042）、输注新鲜冰冻血浆（FFP）（P=1.208，95%CI：1.037-1.408，P=0.015）以及ECMO支持期间的最低血小板（PLT）计数（P=0.977，95%CI：0.958-0.996，P=0.019）有关。ICH预测模型的受试者工作特征曲线下面积为0.843（95%CI：0.762-0.924，P<0.001）。
接受ECMO治疗的ICH患者死亡风险更高。GWR、卒中病史、FFP输注和最低PLT计数与ICH独立相关，且ICH预测模型显示这些参数作为诊断工具表现良好。
