|
|
|
|
|
| Clinical characteristics and prognostic risk factors of patients with acute decompensated heart failure treated by extracorporeal membrane oxygenation |
| Fan Yan-hui, Liu Lu-na, Zhou Rui |
| Department of Cardiology, Shihezi People′s Hospital, Shihezi 832000, China |
|
|
|
|
Abstract Objective To evaluate the clinical characteristics and poor prognostic risk factors of patients with acute decompensated heart failure treated venoarterial extracorporeal membrane oxygenation (VA-ECMO). Methods To retrospective analyze the clinical data of 96 patients with acute decompensated heart failure treated in ICU. The clinical characteristics of the patients were analyzed. According to the patient's survival for 1 year, the patients were divided into the death group and the survival group. The demographic data, cardiomyopathy type, disease severity, ECMO treatment characteristics, disease onset time, laboratory index and prognosis were compared between the two groups. Logistic regression analysis was used to evaluate the independent risk factors for 1-year mortality in patients. Results The 1-year survival rate was 42.7%(41/96) and the mortality rate was 57.3%(55/96). Univariate analysis showed that factors associated with death included age (t=2.005, P=0.047), idiopathic cardiomyopathy (χ2=5.985, P= 0.014), years of cardiac disease(t=15.735, P<0.001), admission to Simplified Acute Physiology Score Ⅱ (SAPSⅡ)(Z=15.382, P<0.001), adjuvant therapy Pre-sequential organ failure assessment (SOFA)(Z=4.336, P<0.001), lung (χ2=6.192, P=0.013) kidney (χ2=5.692, P=0.017) liver (χ2=70754, P=0.005) failure, cardiac arrest(χ2=4.174,P=0.041), ECMO-assisted extracorporeal cardiopulmonary resuscitation (ECPR)(χ2=5.245, P=0.022) and blood lactate (t=5.518, P<0.001). Independent risk factors for 1-year mortality included: SOFA score>11 (P=0.022), duration of heart disease>2 years (P=0.025), blood lactate>4 mmol/L (P=0.047) and idiopathic cardiomyopathy (P=0.023). The 1-year survival rate of patients with ECMO-assisted SOFA score<7 was 50.0%, and that of patients with SOFA score of ≥14 was 9.6%, suggesting that ECMO-assisted therapy is less effective in patients with severe decompensated heart failure. Conclusion The 1-year survival rate of patients with acute decompensated heart failure treated with VA-EMCO is 42.7%. The prognosis of a patient depends mainly on the severity of the heart disease. Patients with multiple organ failure treated with ECMO are at greater risk of death. Clinicians should be cautious about the patients with an ECMO-assisted SOFA score of no less than 14.
|
|
|
|
Corresponding Authors:
Zhou Rui, E-mail：jasonzhouxj@163.com
|
|
|
|
| ［1］胡盛寿. 心力衰竭外科治疗现状与进展［J］. 中国循环杂志, 2016, 31(3): 209-213.
［2］Broch K, Murbr?ch K, Andreassen AK, et al. Contemporary Outcome in Patients With Idiopathic Dilated Cardiomyopathy［J］. Am J Cardiol, 2015, 116(6): 952-959.
［3］陈少敏, 郭丽君. 经皮机械循环支持装置在重症心血管疾病中的应用进展［J］. 中华危重病急救医学, 2016, 28(12): 1161-1164.
［4］Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults［J］. J Am Coll Cardiol, 2014, 63(25 Pt A):2769-7278.
［5］姑丽娜扎尔·艾比布拉, 穆叶赛·尼加提, 李国庆. 体外膜肺氧合技术在急性心肌梗死中的临床应用与研究进展［J］. 中国心血管病研究, 2018, 16(5): 400-403.
［6］王红，李呈龙，田夏秋，等.心脏外科围术期体外膜肺氧合输助患者目标浅镇静的效果和安全性［J］. 中国医药， 2018, 13(2): 191-195.
［7］中华医学会心血管病学分会,中华心血管病杂志编辑委员会. 急性心力衰竭诊断和治疗指南［J］. 中华心血管病杂志, 2010, 38(3): 195-208.
［8］Pineton de Chambrun M, Bréchot N, Lebreton G, et al. Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock post-cardiac arrest［J］. Intensive Care Med, 2016, 42(12): 1999-2007.
［9］Muller G, Flecher E, Lebreton G, et al. The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock［J］. Intensive Care Med, 2016, 42(3): 370-378.
［10］Shah M, Patel B, Tripathi B, et al. Hospital mortality and thirty day readmission among patients with non-acute myocardial infarction related cardiogenic shock［J］. Int J Cardiol, 2018, 270: 60-67.
［11］Pappalardo F, Ajello S, Greco M, et al. Contemporary applications of intra-aortic balloon counterpulsation for cardiogenic shock: a “real world” experience［J］. J Thorac Dis, 2018, 10(4): 2125-2134.
［12］刘瑞金. 静脉动脉体外膜肺氧合在心源性休克中的应用［J］. 中国急救医学, 2017, 37(2): 189-192.
［13］李南，冯期婷，韩静.心源性休克采用体外膜肺氧合支持的相关危险因素分析［J］. 中国医药, 2013, 8(5): 602-604.
［14］Chaggar PS, McKay EJ, Foden P, et al. Clinical characteristics and survival in cardiogenic shock admissions to a UK heart transplant unit［J］. Future Cardiol, 2018, 14(5): 397-406.
［15］Petroni T, Harrois A, Amour J, et al. Intra-aortic balloon pump effects on macrocirculation and microcirculation in cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation［J］. Crit Care Med, 2014, 42(9): 2075-2082.
［16］Hawranek M, Gierlotka M, Pres D, et al. Nonroutine Use of Intra-Aortic Balloon Pump in Cardiogenic Shock Complicating Myocardial Infarction With Successful and Unsuccessful Primary Percutaneous Coronary Intervention［J］. JACC Cardiovasc Interv, 2018, 11(18): 1885-1893.
［17］Huu AL, Shum-Tim D. Intra-aortic balloon pump: current evidence & future perspectives［J］. Future Cardiol, 2018, 14(4): 319-328.
［18］Loyaga-Rendon RY, Acharya D, Pamboukian SV, et al. Duration of Heart Failure Is an Important Predictor of Outcomes After Mechanical Circulatory Support［J］. Circ Heart Fail, 2015, 8(5): 953-959.
［19］Fülster S, Tacke M, Sandek A, et al. Muscle wasting in patients with chronic heart failure: results from the studies investigating co-morbidities aggravating heart failure (SICA-HF) ［J］. Eur Heart J, 2013, 34(7): 512-519.
［20］于彤彤, 王传合, 王菁菁, 等. 老年慢性心力衰竭患者的临床特点分析［J］. 中华老年医学杂志, 2015, 34(9): 947-950. |
|
|
|
Address: 1 North 2nd Street,
Zhongguancun, 
