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首页> 外文期刊>Artificial Organs >Five-Year Results of 121 Consecutive Patients Treated With Extracorporeal Membrane Oxygenation at Fu Wai Hospital
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Five-Year Results of 121 Consecutive Patients Treated With Extracorporeal Membrane Oxygenation at Fu Wai Hospital

机译：富维医院121例连续性体外膜氧合治疗患者的五年结果

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Since 2004, our institution has adopted venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for patients who otherwise could not be weaned from cardiopulmonary bypass and patients experiencing cardiogenic shock and/or pulmonary dysfunction unresponsive to conventional treatments. In this study, we reviewed our experience with ECMO support and tried to identify predictors of in-hospital mortality. We retrospectively analyzed the clinical records of 121 consecutive patients receiving ECMO. Patients were divided into adult and pediatric groups and analyzed separately. Demographics, clinical characteristics at the time of ECMO implantation, ECMO-related complications, and in-hospital mortality were collected. Logistic regression analyses were performed to investigate predictors of mortality. A P value ≤0.05 was accepted as significant. Sixty-eight adult patients and 53 pediatric patients were included in this study. In adult patients, 52 were weaned from ECMO and 43 survived upon discharge. After univariate analysis, ECMO setup location, receiving cardiopulmonary resuscitation before ECMO, leg ischemia, hemolysis, acute renal failure (ARF), neurological dysfunction, and multiple organ dysfunction syndrome were associated with in-hospital death. In multiple logistic regression analyses, leg ischemia (OR 14.68, 95% CI 1.67–129.1), ARF (OR 12.14, 95% CI 2.5–58.8), and neurological dysfunction (OR 49.0, 95% CI 2.28–1051.96) were risk factors associated with in-hospital mortality. Patients put on ECMO in the operating room had a better chance of survival (OR 0.078, 95% CI 0.013–0.417). In pediatric patients, 30 were weaned from ECMO and 26 survived upon discharge. After univariate analysis, age, weight, and eight ECMO complications were associated with in-hospital death. In multiple logistic regression analyses, ARF (OR 24.0, 95% CI 4.2–137.3) was a risk factor associated with in-hospital mortality. A P value of 0.921 and >0.99 was obtained by the Hosmer–Lemeshow test, and the area under the curve was 0.863 and 0.867 for adult and pediatric patients, respectively. The overall survival rate was 57%. ECMO is a justifiable alternative treatment for refractory cardiac and/or pulmonary dysfunction which could rescue more than 50% of carefully selected patients. Higher survival rates could be achieved by preventing ECMO complications.
机译：自2004年以来，我们的机构对无法通过心肺分流术断奶的患者以及因常规治疗无反应的心源性休克和/或肺功能不全的患者采用了静脉大动脉（VA）体外膜氧合（ECMO）。在这项研究中，我们回顾了我们在ECMO支持下的经验，并试图确定住院死亡率的预测因素。我们回顾性分析了连续121例接受ECMO的患者的临床记录。将患者分为成人和儿童组，并分别进行分析。收集人口统计学资料，植入ECMO时的临床特征，与ECMO相关的并发症以及医院内死亡率。进行逻辑回归分析以研究死亡率的预测因子。 P值≤0.05被认为是显着的。这项研究包括68名成人患者和53名儿科患者。在成年患者中，有52名从ECMO断奶，有43名在出院后存活。经过单因素分析后，ECMO的设置位置，在ECMO之前接受心肺复苏，腿部缺血，溶血，急性肾衰竭（ARF），神经功能障碍和多器官功能障碍综合征与医院内死亡相关。在多项逻辑回归分析中，腿部缺血（OR 14.68，95％CI 1.67–129.1），ARF（OR 12.14，95％CI 2.5–58.8）和神经功能障碍（OR 49.0，95％CI 2.28–1051.96）是危险因素与医院内死亡率相关。在手术室放ECMO的患者有更好的生存机会（OR 0.078，95％CI 0.013–0.417）。在儿科患者中，有30名从ECMO断奶，有26名在出院后存活。单因素分析后，年龄，体重和八种ECMO并发症与院内死亡相关。在多项逻辑回归分析中，ARF（OR 24.0，95％CI 4.2-137.3）是与院内死亡率相关的危险因素。 Hosmer–Lemeshow检验获得的P值为0.921和> 0.99，成人和儿童患者的曲线下面积分别为0.863和0.867。总体生存率为57％。 ECMO是难治性心脏和/或肺功能不全的合理替代疗法，可以挽救超过50％的精心挑选的患者。预防ECMO并发症可以提高生存率。

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