在VA ECMO期间的肺动脉压力和死亡率:一个ELSO注册分析
Clark G Owyang1,2, Brady Rippon3, Felipe Teran2
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.
medRxiv : the preprint server for health sciences
|August 30, 2023
概括
在静脉外体膜氧化 (VA ECMO) 期间改善右心室 (RV) 功能与降低死亡率有关. 早期的RV功能改善预测心脏ECMO患者的更好的生存结果.
科学领域:
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
- 心血管外科心血管外科
背景情况:
- 系统血液动力学和呼吸器设置预测了静脉外体膜氧化 (VA ECMO) 的生存率.
- 在VA ECMO期间右心室 (RV) 功能和生存率之间的独立关系仍然不清楚.
- RV功能与影响VA ECMO结果的血液动力学因素密切相关.
研究的目的:
- 为了确定VR功能和VA ECMO期间死亡率之间的关联.
- 调查RV功能与ECMO支持的持续时间之间的关系.
- 评估VR函数对VA ECMO结果的预测价值.
主要方法:
- 从ELSO注册表 (2010-2022) 分析了4,442个成年心脏VA ECMO病例.
- 在ECMO前和ECMO后使用肺动脉脉冲压 (PAPP) 量化RV功能.
- 多变量建模根据SCAI阶段,年龄,性别和临床数据进行调整;主要结局是住院死亡率.
主要成果:
- 总的死亡率为55%.
- 从ECMO前到ECMO后PAPP的改善 (Δ PAPP) 与死亡率的降低相关 (OR:每10毫米升0.91).
- 在ECMO上增加的PAPP与更长的ECMO持续时间有关 (Beta:每10毫米升15).
结论:
- 在VA ECMO期间VR功能早期改善与死亡率降低有关.
- 建议将Δ PAPP纳入心脏ECMO患者的风险预测模型.
- 在VA ECMO中,RV功能是生存的关键,独立的预测因素.
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