Grazioli Alison, Plazak Michael Edward, Willsey Kate, Rabin Joseph, Rector Raymond P, Belyayev Leonid, Lankford Allison S, Scalea Thomas M, Shah Aakash, Taylor Bradley S, Gladwin Mark T
University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, Program in Trauma, Baltimore, Maryland, United States.
University of Maryland Medical Center, Baltimore, Maryland, United States.
Blood Adv. 2025 Jul 11. doi: 10.1182/bloodadvances.2025016368.
The utility of extracorporeal membrane oxygenation (ECMO) support for adult patients with sickle cell disease (SCD) remains poorly understood. We aimed to characterize a cohort of adult individuals with SCD in the Extracorporeal Life Support Organization (ELSO) registry who underwent venoarterial (VA) or venovenous (VV) ECMO treatment, assess clinical outcomes for each modality and determine predictors of mortality. This multicenter, retrospective study evaluated in-hospital mortality and clinical outcomes such as bleeding and thrombotic events (BTE) of adult VA and VV ECMO ELSO registry patients with SCD associated ICD-9/10-CM codes. Post hoc multivariable logistic regression model was developed assessing predictors of mortality. Of 206 included patients, 126 and 80 were cannulated for VA ECMO or VV ECMO, respectively. Eighty-three patients (40.3%) were discharged alive; In-hospital survival was 25.5% and 61.1% for VA and VV ECMO, respectively (p<0.001). BTE was common during VA (45.6%) and VV (33.8%) ECMO support. There was significant increase in BTE incidence for non-survivors compared to survivors with VA ECMO (55.4% vs. 26.5%, p<0.001) and VV ECMO (58.1% vs. 18.4%, p=0.01). Male sex, increased age, pre-ECLS cardiac arrest, cannulation for eCPR, and elevated lactate were predictive of in-hospital mortality in the VA ECMO cohort. In adult patients with SCD, in-hospital survival was significantly lower with VA ECMO compared to VV ECMO. Male sex, increased age, eCPR support, elevated lactate and pre-ECLS arrest were strongest indicators of VA ECMO mortality. Bleeding and thrombotic complications have an association with in-patient mortality for those treated with ECMO.
体外膜肺氧合（ECMO）对成年镰状细胞病（SCD）患者的支持作用仍知之甚少。我们旨在对体外生命支持组织（ELSO）登记处接受静脉-动脉（VA）或静脉-静脉（VV）ECMO治疗的成年SCD患者队列进行特征描述，评估每种模式的临床结局，并确定死亡率的预测因素。这项多中心回顾性研究评估了成年VA和VV ECMO ELSO登记处患有SCD且伴有ICD-9/10-CM编码的患者的住院死亡率和出血及血栓形成事件（BTE）等临床结局。建立了事后多变量逻辑回归模型来评估死亡率的预测因素。在纳入的206例患者中，分别有126例和80例接受了VA ECMO或VV ECMO插管。83例患者（40.3%）存活出院；VA和VV ECMO的住院生存率分别为25.5%和61.1%（p<0.001）。在VA（45.6%）和VV（33.8%）ECMO支持期间，BTE很常见。与VA ECMO（55.4%对26.5%，p<0.001）和VV ECMO（58.1%对18.4%，p=0.01）的幸存者相比，非幸存者的BTE发生率显著增加。男性、年龄增加、ECLS前心脏骤停、eCPR插管和乳酸升高是VA ECMO队列住院死亡率的预测因素。在成年SCD患者中，VA ECMO的住院生存率显著低于VV ECMO。男性、年龄增加、eCPR支持、乳酸升高和ECLS前心脏骤停是VA ECMO死亡率的最强指标。出血和血栓并发症与接受ECMO治疗的患者的住院死亡率有关。
