同时使用体外膜氧化和皮肤微轴辅助装置支用于心脏性冲击
Shan P Modi1, Yeahwa Hong2, McKenzie M Sicke3
1Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.
JTCVS open
|February 29, 2024
概括
用微轴左心室辅助装置进行静脉外体膜氧化 (VA-ECMO) 有效地管理心脏性休克 (CS). 虽然急性心肌梗塞 (AMI-CS) 和不补偿性心力衰竭 (ADHF-CS) 的存活率相似,但最初接受VA-ECMO的AMI-CS患者面临更高的死亡率.
科学领域:
- 心血管医学 心血管医学
- 机械循环支持 机械循环支持
- 关键的护理关键的护理
背景情况:
- 静脉外体膜氧化 (VA-ECMO) 与皮肤微轴左心室辅助装置 (LVAD) 结合,是心脏性休克 (CS) 的新兴疗法.
- 关于使用这种联合支持策略的CS病因分层的生存结果的数据有限.
研究的目的:
- 为了评估和比较由于急性心肌梗塞 (AMI-CS) 的CS患者的生存结果与VA-ECMO和皮微轴LVAD支持治疗的无补偿心力衰竭 (ADHF-CS).
主要方法:
- 在2020年12月至2023年1月期间治疗的44名患者 (20名AMI-CS,24名ADHF-CS) 的回顾性单中心分析.
- 病因组之间90天出院后的存活率,患者的目的地和并发症 (四肢缺血,急性损伤) 的发生率的比较.
主要成果:
- 退院后90天的整体存活率和支持后的目的地在AMI-CS和ADHF-CS组之间相似 (分别P=.267和P=.220).
- 与其他队列相比,最初接受VA-ECMO支持的AMI-CS患者的90天生存率明显较低 (P=.038).
- 肢体缺血和急性损伤在AMI-CS组中更频繁 (分别P=.013和P=.030).
结论:
- VA-ECMO和皮肤穿微轴LVAD的组合是管理CS的可行策略.
- 在使用这种支持策略的AMI-CS和ADHF-CS患者之间,生存或目的地没有显著差异.
- 需要初始VA-ECMO支持的AMI-CS患者的死亡率增加,需要在多中心研究中进一步调查.
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