在使用外围VA-ECMO时,与中风相关的发生率和危险因素
Mohamed Ramzi Almajed1, Raef A Fadel2, Austin Parsons1
1Department of Internal Medicine, Henry Ford Hospital, Detroit, United States of America.
概括
通过静脉动脉外体膜氧化 (VA-ECMO) 的机械循环支持与显著的中风风险有关. 识别P2Y12抗剂和四肢缺血等危险因素对于管理这些神经系统并发症至关重要.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 关键护理医学 关键护理医学
背景情况:
- 通过静脉动脉外体膜氧化 (VA-ECMO) 的机械循环支持,改变了心脏性休克管理.
- 神经性并发症是VA-ECMO患者发病和死亡的主要原因,限制了其使用.
研究的目的:
- 在接受外周VA-ECMO的患者中识别中风风险因素.
- 在这个患者群体中分析中风后30天的住院结果.
主要方法:
- 一个单一中心的回顾性病例控制研究包括244名从2018年1月到2022年9月接受外围VA-ECMO的成年患者.
- 患有中风的患者 (n=36) 与没有中风的患者进行了比较,使用多变量逻辑回归来确定中风风险因素.
- 包括死亡率在内的住院结果被评估到30天.
主要成果:
- 14.7%的患者在VA-ECMO中发生中风,其中55.6%是缺血性和44.4%是出血性.
- 中风的独立风险因素包括使用P2Y12抗剂 (aOR 2.70),肢体缺血 (aOR 4.41),以及输血 (aOR 8.55).
- 女性性别趋向于显著性 (aOR 2.19),而年龄不是一个显著因素. 脑卒中发展没有影响VA-ECMO持续时间,住院时间或30天死亡率.
结论:
- VA-ECMO与神经系统并发症的严重风险有关,特别是中风.
- 早期识别和治疗中风至关重要,因为肢体缺血和P2Y12抗剂使用等危险因素是可修改的.
- 需要进行进一步的临床试验和多中心研究,以制定减轻VA-ECMO患者中风风险的策略.
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