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Clinical outcomes of venoarterial extracorporeal life support in 462 patients: Single‐center experience

机译：462例患者的静脉内体外寿命支持的临床结果：单中心经验

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Abstract This study aims to investigate the outcomes of venoarterial extracorporeal life support (VA‐ECLS) in a large single‐center patient cohort regarding survival and adverse events. Between June 2009 and March 2019, 462 consecutive patients received VA‐ECLS. The mean age was 66.2 ± 11.9 years. Two patient groups were identified: Group 1—patients with ECLS due to postcardiotomy shock (PCS) after cardiac surgery (PCS, n = 357); Group 2—patients with ECLS due to cardiogenic shock (CS) without previous surgery (nonPCS, n = 105). The primary end point was overall in‐hospital survival, while secondary end points were adverse events during the study period. Overall, the in‐hospital survival rate was 26%. There was no statistically significant difference between the groups: 26.3% for PCS and 24.8% for nonPCS, respectively ( P .05). Weaning from VA‐ECLS was possible in 44.3% for PCS and in 29.5% for nonPCS ( P = .004). The strong predictors of overall mortality were postoperative hepatic dysfunction (OR = 14.362, 95%CI = 1.948‐105.858), cardiopulmonary resuscitation 30 minutes (OR = 6.301, 95%CI = 1.488‐26.673), bleeding with a need for revision (OR = 2.123, 95%CI = 1.343‐3.355), and previous sternotomy (OR = 2.077, 95%CI = 1.021‐4.223). Despite its low survival rates, VA‐ECLS therapy is the last resort and the only lifesaving option for patients in refractory CS. In contrast, there is still a lack of evidence for VA‐ECLS in PCS patients. Future studies are warranted to evaluate the outcomes of VA‐ECLS therapy after cardiac surgery.
机译：摘要本研究旨在调查静脉内体外寿命支持（VA-ECL）的疗效，在大型单中心患者队列关于存活和不良事件的情况下。 2009年6月至2019年3月，462名连续患者收到VA-ECL。平均年龄为66.2±11.9岁。鉴定了两种患者组：1组 - 由于心脏手术（PC，N = 357）后由于后心动术休克（PC）引起的eCL患者;第2组 - 由于患有先前手术的心绞痛（CS）引起的ECL患者（非耐药，N = 105）。主要终点在医院内存的存活率，而次要终点在研究期间是不良事件。总体而言，住院存活率为26％。组之间没有统计学上显着的差异：PCS的26.3％和24.8％的非稀有量（P＆GT; .05）。 VA-ECLS断奶在44.3％的PC中，非净值的29.5％（P = .004）。总体死亡率的强大预测因子是术后肝功能障碍（或= 14.362,95％CI = 1.948-105.858），心肺复苏和GT; 30分钟（或= 6.301,95％CI = 1.488-26.673），需要修改（或= 2.123,95％CI = 1.343-3.355），之前胸骨切开术（或= 2.077,95％CI = 1.021- 4.223）。尽管其生存率低，但VA-ECLS疗法是难治性CS中患者的最后一个手段和唯一的救生选择。相比之下，PCS患者的VA-ECL仍然缺乏证据。未来的研究是有必要评估心脏手术后VA-ECLS治疗的结果。

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