目的:心脏切开术后体外膜氧合(ECMO)可以根据适应症在手术中或手术后开始,设置,患者概况和条件。植入时机的话题直到最近才引起临床界的关注。我们比较病人的特征,术中和术后ECMO的住院和长期生存率。
方法:回顾性研究,多中心,观察性心脏切开术后体外生命支持(PELS-1)研究包括2000年至2020年因心脏切开术后休克而需要ECMO的成年人.我们比较了在手术室(术中)接受ECMO的患者和在重症监护病房(术后)接受ECMO的患者的住院和出院后结果。
结果:我们研究了2003例患者[女性:41.1%;中位年龄:65(IQR:55.0-72.0)岁]。术中(n=1287),与术后相比(n=716),ECMO患者的术前风险状况较差。心源性休克(45.3%),右心室衰竭(15.9%),心脏骤停(14.3%)是术后开始ECMO的主要指征,插管后(中位数)1天(IQR:1-3天)。与术中应用相比,术后ECMO显示更多并发症,心脏再手术(术中:19.7%;术后:24.8%,p=0.011),经皮冠状动脉介入治疗(术中:1.8%;术后:3.6%,p=0.026),住院死亡率较高(术中:57.5%;术后:64.5%,p=0.002)。在医院幸存者中,术中ECMO后ECMO持续时间较短(中位数:104,IQR:67.8-164.2小时),与术后ECMO(中位数:139.7,IQR:95.8-192小时,p<0.001),而两组的出院后长期生存率相似(p=0.86).
结论:术中和术后ECMO植入与不同的患者特征和结局相关,术后ECMO并发症和院内死亡率较高。确定与特定患者特征相关的心脏切开术后ECMO的最佳位置和时机的策略是必要的,以优化院内结局。
Postcardiotomy extracorporeal membrane oxygenation (ECMO) can be initiated intraoperatively or postoperatively based on indications, settings, patient profile, and conditions. The topic of implantation timing only recently gained attention from the clinical community. We compare patient characteristics as well as in-hospital and long-term survival between intraoperative and postoperative ECMO.
The retrospective, multicenter, observational Postcardiotomy Extracorporeal Life Support (PELS-1)
study includes adults who required ECMO due to postcardiotomy shock between 2000 and 2020. We compared patients who received ECMO in the operating theater (intraoperative) with those in the intensive care unit (postoperative) on in-hospital and postdischarge outcomes.
We studied 2003 patients (women: 41.1%; median age: 65 years; interquartile range [IQR], 55.0-72.0). Intraoperative ECMO patients (n = 1287) compared with postoperative ECMO patients (n = 716) had worse preoperative risk profiles. Cardiogenic shock (45.3%), right ventricular failure (15.9%), and cardiac arrest (14.3%) were the main indications for postoperative ECMO initiation, with cannulation occurring after (median) 1 day (IQR, 1-3 days). Compared with intraoperative application, patients who received postoperative ECMO showed more complications, cardiac reoperations (intraoperative: 19.7%; postoperative: 24.8%, P = .011), percutaneous coronary interventions (intraoperative: 1.8%; postoperative: 3.6%, P = .026), and had greater in-hospital mortality (intraoperative: 57.5%; postoperative: 64.5%, P = .002). Among hospital survivors, ECMO duration was shorter after intraoperative ECMO (median, 104; IQR, 67.8-164.2 hours) compared with postoperative ECMO (median, 139.7; IQR, 95.8-192 hours, P < .001), whereas postdischarge long-term survival was similar between the 2 groups (P = .86).
Intraoperative and postoperative ECMO implantations are associated with different patient characteristics and outcomes, with greater complications and in-hospital mortality after postoperative ECMO. Strategies to identify the optimal location and timing of postcardiotomy ECMO in relation to specific patient characteristics are warranted to optimize in-hospital outcomes.