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首页> 外文期刊>Journal of Intensive Care >ECMO-treatment in patients with acute lung failure, cardiogenic, and septic shock: mortality and ECMO-learning curve over a 6-year period
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ECMO-treatment in patients with acute lung failure, cardiogenic, and septic shock: mortality and ECMO-learning curve over a 6-year period

机译：急性肺衰竭，心源性和败血性休克患者的ECMO治疗：6年期间的死亡率和ECMO学习曲线

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Background Based on promising results over the past 10?years, the method of extracorporeal membrane oxygenation (ECMO) has developed from being used as a ‘rescue therapy’ to become an accepted treatment option for patients with acute lung failure (ARDS). Subsequently, the indication was extended also to patients suffering from cardiogenic and septic shock. Our aim was to evaluate hospital mortality and associated prognostic variables in patients with lung failure, cardiogenic, and septic shock undergoing ECMO. Furthermore, a cumulative sum (CUSUM) analysis was used to assess the learning curve of ECMO-treatment in our department. Methods We retrospectively analysed the data of 131 patients undergoing ECMO treatment in the intensive care unit of the Asklepios Hospital of Langen over the time period from April 2011 to July 2016. We categorised the patients into three groups: lung failure ( n =?54); cardiogenic shock ( n =?58); and septic shock ( n =?19). The primary outcome variable was hospital mortality along with identification of prognostic variables on mortality before initiating ECMO using logistic regression. Second outcome variable was the learning curve of our department in patients with ECMO. Results 6-year hospital mortality was 54% in patients with lung failure, 59% in patients with cardiogenic shock, and 58% in patients with septic shock. The CUSUM analysis revealed a typical learning curve with a point of inflection in the year 2014. Patients treated before 2014 had a worse outcome ( p =?0.04 whole cohort; p =?0.03 for lung failure). Furthermore, less than 20 treatments per year respectively treatment before 2014 were associated negatively with hospital mortality of lung failure patients showing an odds ratio of 4.04, as well as in the entire cohort with an odds ratio of 3.19. Conclusion For the first time, a steep ECMO-learning curve using the CUSUM tool has been described. Obviously, the experience with ECMO has to be taken into account when defining the role of ECMO in ARDS, cardiogenic, and septic shock.
机译：背景技术基于过去10年来的良好结果，体外膜氧合（ECMO）方法已从“挽救疗法”发展成为急性肺衰竭（ARDS）患者的公认治疗选择。随后，适应症也扩大到患有心源性和败血性休克的患者。我们的目的是评估接受ECMO治疗的肺衰竭，心源性和败血性休克患者的医院死亡率和相关的预后变量。此外，我们使用累积总和（CUSUM）分析来评估ECMO治疗的学习曲线。方法回顾性分析2011年4月至2016年7月在Langen的Asklepios医院重症监护室接受131例ECMO治疗的患者的数据。我们将患者分为三类：肺衰竭（n =？54） ;心源性休克（n =？58）;和败血性休克（n =？19）。主要结局变量是医院死亡率，以及使用logistic回归启动ECMO之前确定死亡率的预后变量。第二个结果变量是我科ECMO患者的学习曲线。结果肺衰竭患者的6年医院死亡率为54％，心源性休克患者为59％，败血性休克患者为58％。 CUSUM分析显示，2014年出现典型的学习曲线并出现拐点。2014年前接受治疗的患者预后较差（整个队列的p =？0.04;肺衰竭的p =？0.03）。此外，2014年之前每年分别少于20种治疗与肺衰竭患者的医院死亡率呈负相关，其赔率比为4.04，在整个队列中的赔率比为3.19。结论首次描述了使用CUSUM工具的陡峭ECMO学习曲线。显然，在定义ECMO在ARDS，心源性和败血性休克中的作用时，必须考虑ECMO的经验。

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