Hao Jing-Yan, Wang Shi-Fu, Yang Qin, Wang Wei, Zhao Zhuo-Xian, Guo Shan, Zhou Ying, Dong Fei, Lin Wen-Hua
Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin 300457, China.
Intensive Care Unit, TEDA International Cardiovascular Hospital, Tianjin 300450, China.
World J Cardiol. 2025 Aug 26;17(8):109903. doi: 10.4330/wjc.v17.i8.109903.
Data on adsorptive extracorporeal membrane oxygenation (ECMO) (combined with HA380 hemoperfusion column) on the inflammatory factors in patients with cardiogenic shock (CS) remains limited.
To investigate the effects of adsorptive ECMO on the inflammatory factors in patients with CS.
A retrospective analysis was performed on 81 patients with CS caused by acute myocardial infarction, fulminant myocarditis, or cardiac surgery who required venoarterial ECMO support at TEDA International Cardiovascular Hospital from December 2020 to December 2024. Patients were divided into the conventional ECMO group (42 cases) and the adsorptive ECMO group (ECMO combined with hemoperfusion, 39 cases). The adsorptive ECMO group received 2 columns of HA380 initiation on the first day (the first column connected within 2 hours of ECMO and the second after 12 hours of ECMO), followed by 1 column each day, with each column used for 4-6 hours, totaling 24-30 hours of treatment. Baseline data were compared between the two groups: Inflammatory factor levels (at 0, 6, 12, 24, 48, and 72 hours after ECMO or hemoperfusion initiation); ECMO support duration; successful weaning rate; continuous renal replacement therapy (CRRT) utilization; Sequential Organ Failure Assessment (SOFA) score; Vasoactive-Inotropic Score (VIS); systemic inflammatory response syndrome (SIRS) incidence; and in-hospital survival and 30-/90-day survival after discharge.
The adsorptive ECMO group showed significantly lower levels of C-reactive protein, interleukin (IL)-6, tumor necrosis factor (TNF)-α, and lactate from 6 to 72 hours compared with the conventional ECMO group (all < 0.05), with IL-6 decreasing by 94.4% and tumour necrosis factor alpha by 70.1% from baseline at 72 hours. The adsorptive ECMO group had a significantly shorter ECMO duration [114.0 (75.0-139.0) hours 135.0 (73.0-199.3) hours, = 0.032]; higher successful weaning rate (66.7% 42.9%, = 0.032); a trend toward lower CRRT utilization (54.8% 38.5%, = 0.070); lower post-weaning SOFA score [7 (6-8) 9 (8-10), < 0.001]; significantly reduced VIS (8.4 ± 1.3 9.8 ± 1.6, < 0.001); and a trend toward lower SIRS incidence (10.3% 26.2%, = 0.065). There were no significant differences in complications, in-hospital survival (64.1% 52.4%, = 0.285); or 30-/90-day survival between the two groups (all > 0.05).
Adsorptive ECMO efficiently clears IL-6 and TNF-α, significantly improving ECMO weaning success rate and hemodynamics. However, it has no significant impact on survival, and its efficacy requires validation through prospective studies.
关于吸附性体外膜肺氧合（ECMO）（联合HA380血液灌流柱）对心源性休克（CS）患者炎症因子影响的数据仍然有限。
探讨吸附性ECMO对CS患者炎症因子的影响。
对2020年12月至2024年12月在泰达国际心血管病医院因急性心肌梗死、暴发性心肌炎或心脏手术导致CS且需要静脉-动脉ECMO支持的81例患者进行回顾性分析。患者分为传统ECMO组（42例）和吸附性ECMO组（ECMO联合血液灌流，39例）。吸附性ECMO组在第一天启动2柱HA380（第一柱在ECMO开始后2小时内连接，第二柱在ECMO开始后12小时连接），随后每天1柱，每柱使用4 - 6小时，共治疗24 - 30小时。比较两组的基线数据：炎症因子水平（在ECMO或血液灌流开始后0、6、12、24、48和72小时）；ECMO支持时间；成功撤机率；持续肾脏替代治疗（CRRT）使用率；序贯器官衰竭评估（SOFA）评分；血管活性-正性肌力评分（VIS）；全身炎症反应综合征（SIRS）发生率；以及住院生存率和出院后30/90天生存率。
与传统ECMO组相比，吸附性ECMO组在6至72小时时C反应蛋白、白细胞介素（IL）-6、肿瘤坏死因子（TNF）-α和乳酸水平显著降低（均P < 0.05），72小时时IL-6较基线下降94.4%，肿瘤坏死因子α下降70.1%。吸附性ECMO组的ECMO持续时间显著缩短[114.0（75.0 - 139.0）小时对135.0（73.0 - 199.3）小时，P = 0.032]；成功撤机率更高（66.7%对42.9%，P = 0.032）；CRRT使用率有降低趋势（54.8%对38.5%，P = 0.070）；撤机后SOFA评分更低[7（6 - 8）对9（8 - 10），P < 0.001]；VIS显著降低（8.4±1.3对9.8±1.6，P < 0.001）；SIRS发生率有降低趋势（10.3%对26.2%，P = 0.065）。两组在并发症、住院生存率（64.1%对52.4%，P = 0.285）或30/90天生存率方面无显著差异（均P > 0.05）。
吸附性ECMO能有效清除IL-6和TNF-α，显著提高ECMO撤机成功率和改善血流动力学。然而，它对生存率无显著影响，其疗效需要通过前瞻性研究验证。
