Objective: To assess the factors associated with outcome of patients undergoing extracorporeal membrane oxygenation (ECMO) in a large ECMO center. Methods: Patients aged >18 years who received ECMO support for postcardiotomy cardiogenic shock were identified between January 2011 and December 2015. One hundred and seventy-seven patients (64.8%) successfully weaned from ECMO. These patients were divided into two groups depending on whether they could survive to hospital discharge: the survival group (group S, n=119) and death group (group D, n=58). Multivariate logistic regression was performed to identify risk factors independently associated with in-hospital mortality. Results: Compared to those from group D, patients in group S exhibited a younger age[(53.4±11.7) vs (58.9±11.5) years], a lower inotrope score at the beginning of ECMO [25(15, 60) vs 35.0(23, 60)], a lower average platelets transfusion [4.0(2.0, 5.2) vs 5.0(3.0, 7.2)U] (all P<0.05). There were shorter duration of ECMO support [95.0(73.0, 131.0) vs 120.0(95.8, 160.2) h], shorter ventilation time [137.0(70.0, 236.8) vs 215.0(164.0, 305.0) h], shorter stay in ICU [182.0(140.0, 236.0) vs 259.0(207.0, 382.0) h] and longer hospital stay after weaned from ECMO [14(11, 24) vs 8(4, 16) d] in group S patients compared to those in group D (all P<0.05). Age>65 years (P=0.046), neurologic complications (P<0.001) and lower extremity ischemia (P<0.001) during ECMO support, left ventricular ejection fraction<35% (P=0.011) and central venous pressure (CVP)>12 cmH(2)O(P=0.018) when weaned from ECMO, and the multi-organ function failure (P<0.001) after weaned from ECMO were independently associated with in-hospital mortality. Conclusions: Neurologic complications and lower extremity ischemia that occurred during ECMO, multi-organ function failure after weaned from ECMO had a significant impact on in-hospital mortality. Further studies are needed to prevent neurologic complications and lower extremity ischemia in these patients. Interventions that could reduce these complications may improve outcome.
目的： 分析影响成人心脏术后心源性休克接受体外膜肺氧合(ECMO)循环辅助成功脱机患者的临床预后。 方法： 回顾性分析2011年1月至2015年12月期间北京安贞医院成人心脏术后心源性休克接受ECMO辅助成功脱机的177例患者临床资料，根据临床转归分为两组，即出院存活组(119例)和住院死亡组(58例)。比较两组患者术前一般临床资料和ECMO辅助相关情况，分析影响患者临床预后的风险因素。 结果： 与死亡组患者相比较，存活组患者平均年龄较低[(53.4±11.7)比(58.9±11.5)岁)]，ECMO辅助前血管活性药物指数较低[25(15，60)比35(23，60)]、使用血小板较少[4.0(2.0，5.2)比5.0(3.0，7.2)U]，ECMO辅助时间[95.0(73.0，131.0)比120.0(95.8，160.2) h]、机械通气时间[137.0(70.0，236.8)比215.0(164.0，305.0) h]、重症监护病房(ICU)停留时间[182.0(140.0，236.0)比259.0(207.0，382.0) h]均较短，而ECMO脱机后住院时间[14(11，24)比8(4，16) d]较长，差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示，高龄(>65岁)(P＝0.046)、撤机时左心室射血分数<35%(P＝0.011)、撤机时中心静脉压(CVP)>12 cmH(2)O(P＝0.018)、神经系统并发症(P<0.001)、严重下肢缺血(P<0.001)和多器官功能衰竭(P<0.001)是ECMO脱机后住院死亡的独立风险因素。 结论： 神经系统并发症、下肢严重缺血和多器官功能衰竭是影响成人心源性休克患者接受ECMO辅助成功脱机后临床转归的风险因素，减少其发生率可能是提高患者脱机后出院存活率的有效途径。.
Keywords: Cardiac surgical procedures; Extracorporeal membrane oxygenation; Prognosis; Shock, cardiogenic.