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仅用体外膜氧化治疗的住院结果与与皮肤穿透左心室辅助装置相结合的结果

Fatima Lakhani¹, Bertrand Ebner¹, Crystal Lihong Yan²

¹Division of Cardiology, University of Miami/Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL 33136, USA.

Cardiovascular revascularization medicine : including molecular interventions

|April 25, 2024

概括

在静脉动脉外体膜氧化 (ECMO) 中添加穿皮左心室辅助装置 (pLVAD) 会增加心脏性休克患者的死亡率和中风风险. 然而,这种联合治疗可能会减少出血并发症.

科学领域:

心脏病学心脏病学
心血管外科心血管外科
关键护理医学关键护理医学

背景情况:

静脉动脉外体膜氧化 (ECMO) 可以增加后负荷,可能阻碍心肌恢复.
穿皮左心室辅助装置 (pLVAD) 用于ECMO来卸载左心室的负载.
在心脏病性休克患者中,单独ECMO和ECMO加pLVAD的住院结局需要评估.

研究的目的:

为了比较接受ECMO单独治疗的患者和接受ECMO加pLVAD治疗心脏性休克的患者之间的住院结果.
评估联合治疗对死亡率,中风和出血并发症的影响.
调查急性冠状动脉综合征心脏性休克 (ACS-CS) 患者的一个小组的结果.

主要方法:

国家住院患者样本数据库 (2011-2019) 的回顾性分析.
包括20171名心脏性休克患者,接受ECMO治疗.
后勤回归分析以调整共变量并比较组之间的结果.

主要成果:

与单独使用ECMO (79.6%) 相比,ECMO加pLVAD组 (20.4%) 的死亡率,中风,急性损伤和血管并发症率更高.
调整后的分析显示,联合治疗与增加的死亡率 (OR1.2) 和中风 (OR1.3) 相关,但降低了出血 (OR0.7).
在ACS-CS小组中,联合治疗显示死亡率 (OR 1.3) 和中风 (OR 1.7) 较高,但出血率相似.

结论:

在整体队列中,ECMO加pLVAD在心脏性休克中使用与增加的死亡率和中风有关,降低了出血.
对于ACS-CS患者来说,ECMO加pLVAD也增加了死亡率和中风风险,与单独ECMO相比,出血没有显著差异.
这些发现表明,在将pLVAD添加到ECMO治疗中时,要仔细考虑风险和益处.

关键词:

心脏发生的冲击是心脏的冲击.身体外膜氧化器的氧化左心室辅助装置的使用机械循环支持机械循环支持

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