Chanchayanon Thavat, Saetang Mantana, Wangpholpattanasiri Sutthiphat, Boonchai Ratikorn, Duangpakdee Pongsanae
Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla 90110, Thailand.
Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
Crit Care Res Pract. 2025 Aug 22;2025:5588093. doi: 10.1155/ccrp/5588093. eCollection 2025.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving intervention for refractory cardiopulmonary failure. Identifying factors associated with survival is essential for optimizing patient selection and management. In this study, we aimed to identify VA-ECMO survival predictors and evaluate the associated complications, costs, and outcomes. A retrospective analysis was conducted on data from 123 adult patients who underwent VA-ECMO at the Songklanagarind Hospital between 2017 and 2023. Clinical characteristics, ECMO-related complications, hospital expenses, and survival outcomes were analyzed. Univariate and multivariate logistic regression analyses were used to determine independent predictors of survival. Fifty (40.7%) patients survived until hospital discharge. Compared to central VA-ECMO, peripheral VA-ECMO was significantly associated with improved survival (adjusted OR: 26.44, 95% CI: 1.95-358.7, = 0.014). Preexisting liver dysfunction (adjusted OR: 0.27, 95% CI: 0.09-0.79, = 0.016) and renal dysfunction (adjusted OR: 0.29, 95% CI: 0.1-0.85, = 0.023) were independent mortality predictors. Survival odds were significantly lower in patients with American Society of Anesthesiologists (ASA) Class 5 (adjusted OR: 0.07, 95% CI: 0.01-0.67, = 0.022). Neurological complications were more common in nonsurvivors than in survivors (41.1% vs. 18%, = 0.012). Survivors had significantly higher total hospital costs (997,563.5 vs. 696,191 THB, = 0.004) and longer hospital stays (28.5 vs. 3 days, < 0.001). The multivariate model demonstrated strong predictive performance, with an area under the curve of 0.85. ECMO cannulation strategy, preexisting liver and renal dysfunction, and ASA classification were key factors associated with survival. Peripheral VA-ECMO was associated with better outcomes, and organ dysfunction significantly increased the mortality risk.
静脉-动脉体外膜肺氧合（VA-ECMO）是一种用于治疗难治性心肺衰竭的挽救生命的干预措施。识别与生存相关的因素对于优化患者选择和管理至关重要。在本研究中，我们旨在确定VA-ECMO生存预测因素，并评估相关并发症、成本和结局。对2017年至2023年期间在宋卡那加拉医院接受VA-ECMO治疗的123例成年患者的数据进行了回顾性分析。分析了临床特征、与ECMO相关的并发症、住院费用和生存结局。采用单因素和多因素逻辑回归分析来确定生存的独立预测因素。50例（40.7%）患者存活至出院。与中心VA-ECMO相比，外周VA-ECMO与生存率提高显著相关（调整后的OR：26.44，95%CI：1.95-358.7，P = 0.014）。既往存在肝功能障碍（调整后的OR：0.27，95%CI：0.09-0.79，P = 0.016）和肾功能障碍（调整后的OR：0.29，95%CI：0.1-0.85，P = 0.023）是独立的死亡预测因素。美国麻醉医师协会（ASA）5级患者的生存几率显著较低（调整后的OR：0.07，95%CI：0.01-0.67，P = 0.022）。非幸存者的神经并发症比幸存者更常见（41.1%对18%，P = 0.012）。幸存者的总住院费用显著更高（997,563.5泰铢对696,191泰铢，P = 0.004），住院时间更长（28.5天对3天，P < 0.001）。多因素模型显示出强大的预测性能，曲线下面积为0.85。ECMO插管策略、既往存在的肝肾功能障碍和ASA分级是与生存相关的关键因素。外周VA-ECMO与更好的结局相关，器官功能障碍显著增加死亡风险。
