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应用ECLS-SHOCK资格标准对现实世界队列的结果

Dirk von Lewinski¹, Lukas Herold¹, Eva Bachl¹

¹Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.

Journal of clinical medicine

|November 25, 2023

概括

只有38%的患有心肌梗塞相关心脏性休克的患者符合ECLS-SHOCK试验标准. 现实世界的结果有所不同,这表明VA-ECMO试验结果可能无法对不同患者群体进行概括.

科学领域:

心脏病学心脏病学
关键护理医学关键护理医学
医疗器械技术医疗器械技术

背景情况:

心脏性休克 (CS) 的高住院死亡率约为50%.
ECLS-SHOCK试验发现静脉动脉外体膜氧化 (VA-ECMO) 对心肌梗塞 (MI) 相关的CS的死亡率和次要结果具有中性的影响.
对于ECLS-SHOCK试验结果的现实应用,需要与更广泛的患者队列进行比较.

研究的目的:

将ECLS-SHOCK试验的资格标准与真实世界的一组CS患者进行比较.
评估ECLS-SHOCK试验结果对多样化的患者群体的概括性.
评估符合试验资格和不符合资格的CS患者之间的基线特征和结果的差异.

主要方法:

在PREPARE CS注册表 (SCAI C-E) 中对557名患者应用ECLS-SHOCK资格标准.
分析了机械循环支 (MCS) 的使用情况,与MI相关的CS患病率,以及被排除在ECLS-SHOCK试验之外的原因.
在真实世界队列中,ECLS-SHOCK符合条件和不符合条件的患者之间的30天死亡率与试验数据进行比较.

主要成果:

只有38%的现实CS队列符合ECLS-SHOCK资格标准.
排除原因包括初始乳糖水平低 (43.6%),80岁以上 (16.9%) 和长期心肺复苏>45分钟 (5.7%).
在现实世界队列中,符合ECLS-SHOCK条件的患者的三十天死亡率为57.0%,而ECLS-SHOCK试验的48.4%,具有不同的基线特征.

结论:

在现实世界中,很大一部分与心脏病相关的脑脊髓瘤患者不符合ECLS-SHOCK试验的资格标准.
现实世界CS群体的异质性可能会影响VA-ECMO试验结果的概括性.
需要进一步的研究,以了解VA-ECMO在不同,现实世界的CS患者群体中的影响.

关键词:

这就是VA-ECMO.心脏发生的冲击是心脏性冲击.乳酸乳酸是一种乳酸.机械支持机械支持死亡率死亡率心肌梗塞的心脏病发作

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