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Risk factors for intracranial hemorrhage and mortality in adult patients with severe respiratory failure managed using veno-venous extracorporeal membrane oxygenation

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Chinese Medical Journal 2022年第1期135卷 36-41页

作者： Xiaojing Wu Min Li Ying Cai Tianshu Zhai Yi Zhang Qingyuan Zhan Sichao Gu Department of Pulmonary and Critical Care Medicine Center for Respiratory MedicineChina-Japan Friendship HospitalBeijing 100029China National Clinical Research Center for Respiratory Diseases Beijing 100029China

Background: Intracerebral hemorrhage (ICH) is one of the most severe complications during veno-venous extracorporeal membrane oxygenation (VV-ECMO). This study aimed to determine the risk factors for ICH and mortality in such patients.Methods: We analyzed the clinical data of 77 patients who received VV-ECMO due to severe respiratory failure from July 2013 to May 2019 at China-Japan Friendship Hospital. Demographical data, laboratory indices, imaging characteristics, and other clinical information were collected. Multivariable logistic regression analyses were performed to identify risk factors for ICH and mortality.Results: Of 77 patients, 11 (14.3%) suffered from ICH, and 36 (46.8%) survived. The survival rate was significantly lower (18.2% [2/11]vs. 51.5% [34/66],P = 0.040) in patients with ICH than in those without ICH. Multivariable analysis revealed that factors independently associated with ICH were diabetes mellitus (adjusted odds ratio [aOR]: 12.848, 95% confidence interval [CI]: 1.129-146.188,P = 0.040) and minimum fibrinogen during ECMO (aOR: 2.557, 95% CI: 1.244-5.252,P = 0.011). Multivariable analysis showed that factors independently associated with mortality were acute hepatic failure during ECMO (aOR: 9.205, 95% CI: 1.375-61.604,P = 0.022), CO2 retention before ECMO (aOR: 7.602, 95% CI: 1.514-38.188,P = 0.014), and minimum platelet concentration during ECMO (aOR: 0.130, 95% CI: 0.029-0.577,P = 0.007).Conclusions: Diabetes mellitus and minimum fibrinogen concentration during ECMO are risk factors for ICH in patients with severe respiratory failure managed using VV-ECMO. This indicated that anticoagulants use and nervous system monitoring should be performed more carefully in patients with diabetes when treated with VV-ECMO due to severe respiratory failure.

关键词： veno-venous extracorporeal membrane oxygenation Severe respiratory failure Intracranial hemorrhage Mortality Risk factors

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Association between ICU quality and in-hospital mortality of V-V ECMO-supported patients—the ECMO quality improvement action(EQIA)study:a national cohort study in China from 2017 to 2019

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Frontiers of Medicine 2024年第2期18卷 315-326页

作者： Wei Cheng Jieqing Chen Xudong Ma Jialu Sun Sifa Gao Ye Wang Longxiang Su Lu Wang Wei Du Huaiwu He Yujie Chen Zunzhu Li Qi Li Jianhua Sun Hongbo Luo Jinbang Liu Guangliang Shan Bing Du Yanhong Guo Dawei Liu Chang Yin Xiang Zhou on behalf of the China National Critical Care Quality Control Center-the ECMO quality improvement action(EQIA)study Department of Critical Care Medicine State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing100730China Information Center Department/Department of Information Management State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalPeking Union Medical College&Chinese Academy of Medical SciencesBeijing100730China Department of Medical Administration National Health Commission of the People’s Republic of ChinaBeijing100044China School of Population Medicine and Public Health Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730China Department of Epidemiology and Biostatistics Institute of Basic Medicine SciencesChinese Academy of Medical Sciences(CAMS)&School of Basic MedicinePeking Union Medical CollegeBeijing100730China National Institute of Hospital Administration National Health Commission of the People’s Republic of ChinaBeijing100044China 不详

This cohort study was performed to explore the influence of intensive care unit(ICU)quality on in-hospital mortality of veno-venous(V-V)extracorporeal membrane oxygenation(ECMO)-supported patients in China.The study involved all V-V ECMO-supported patients in 318 of 1700 tertiary hospitals from 2017 to 2019,using data from the National Clinical Improvement System and China National Critical Care Quality Control Center.ICU quality was assessed by quality control indicators and capacity parameters.Among the 2563 V-V ECMO-supported patients in 318 hospitals,a significant correlation was found between ECMO-related complications and prognosis.The reintubation rate within 48 hours after extubation and the total ICU mortality rate were independent risk factors for higher in-hospital mortality of V-V ECMO-supported patients(cutoff:1.5%and 7.0%;95%confidence interval:1.05–1.48 and 1.04–1.45;odds ratios:1.25 and 1.23;P=0.012 and P=0.015,respectively).Meanwhile,the V-V ECMO center volume was a protective factor(cutoff of≥50 cases within the 3-year study period;95%confidence interval:0.57–0.83,odds ratio:0.69,P=0.0001).The subgroup analysis of 864 patients in 11 high-volume centers further strengthened these findings.Thus,ICU quality may play an important role in improving the prognosis of V-V ECMO-supported patients.

关键词： veno-venous extracorporeal membrane oxygenation in-hospital mortality high-volume centers quality control intensive care unit capacity parameters

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Mortality in patients with COVID-19 requiring extracorporeal membrane oxygenation:A meta-analysis

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World Journal of Clinical Cases 2022年第8期10卷 2457-2467页

作者： Ye Zhang Lei Wang Zhi-Xian Fang Jing Chen Jia-Lian Zheng Ming Yao Wen-Yu Chen Department of General Practice Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina Department of Respiration Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina Department of Oncology Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina Department of Pain Medicine Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina

BACKGROUND Coronavirus disease 2019(COVID-19)has become a worldwide pandemic and significant public health issue.The effectiveness of extracorporeal membrane oxygenation(ECMO)in treating COVID-19 patients has been called into question.AIM To conduct a meta-analysis on the mortality of COVID-19 patients who require ECMO.METHODS This analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes 2020(PRISMA)and has been registered at the International Prospective Register of Systematic Reviews(number CRD42020227414).A quality assessment for all the included articles was performed by the Newcastle-Ottawa Scale(NOS).Studies with tenor more COVID-19 patients undergoing ECMO were included.The random-effects model was used to obtain the pooled incidence of mortality in COVID-19 patients receiving ECMO.The source of heterogeneity was investigated using subgroup and sensitivity analyses.RESULTS We identified 18 articles with 1494 COVID-19 patients who were receiving ECMO.The score of the quality assessment ranged from 5 to 8 on the NOS.The majority of patients received veno-venous ECMO(93.7%).Overall mortality was estimated to be 0.31[95%confidence interval(CI):0.24-0.39;I2=84.8%]based on random-effect pooled estimates.There were significant differences in mortality between location groups(33.0%vs 55.0%vs 37.0%vs 18.0%,P<0.001),setting groups(28.0%vs 34.0%,P<0.001),sample size(37.0%vs 31.0%,P<0.001),and NOS groups(39.0%vs 19.0%,P<0.001).However,both subgroup analyses based on location,setting,and sample size,and sensitivity analysis failed to identify the source of heterogeneity.The funnel plot indicated no evident asymmetry,and the Egger’s(P=0.95)and Begg’s(P=0.14)tests also revealed no significant publication bias.CONCLUSION With more resource assessment and risk-benefit analysis,our data reveal that ECMO might be a feasible and effective treatment for COVID-19 patients.

关键词： COVID-19 extracorporeal membrane oxygenation SARS-CoV-2 Meta-analysis veno-venous extracorporeal membrane oxygenation Mortality

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