Long-term outcomes of postcardiotomy patients undergoing venoarterial extracorporeal membrane oxygenation and related risk factors
10.3760/cma.j.cn112434-20220328-00090
- VernacularTitle:冠状动脉旁路移植术后体外膜肺氧合患者远期疗效及预后风险因素分析
- Author:
Juanjuan SHAO
1
;
Xiaotong HOU
;
Liangshan WANG
;
Chengcheng SHAO
;
Fei CHEN
;
Tingting WU
;
Xing HAO
;
Feng YANG
;
Hong WANG
;
Ming JIA
Author Information
1. 首都医科大学附属北京安贞医院心脏外科危重症中心，北京 100029
- Keywords:
Venoarterial extracorporeal membrane oxygenation;
Cardiogenic shock;
Long-term outcomes;
Risk factor
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2022;38(9):548-553
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To examine the long-term survival outcomes and identify mortality risk factors for coronary artery bypass grafting patients who received venoarterial extracorporeal membrane oxygenation(VA-ECMO) for postcardiotomy cardiogenic shock.Methods:Data from 121 consecutive venoarterial extracorporeal membrane oxygenation-treated coronary artery bypass grafting(CABG) patients at Beijing Anzhen Hospital between June 2012 and December 2016 were analyzed. There were 84 males and 24 females. The median age was 62(55, 67) years, and the median body mass index was 25(23, 27)kg/m 2. Thirty-seven patients(34%) had left main artery disease, and 56 patients(52%) underwent off-pump CABG. According to the 3 year survival outcome after ECMO, patients were divided into survival group(35 cases) and non-survival group(73 cases). The differences of clinical indicators between the two groups were compared and analyzed. Multivariable Cox regression modeling was used to identify factors independently associated with 36 month mortality. Results:Sixty-five patients(60%) could be weaned from VA-ECMO, 49 patients(45%) survived to hospital discharge, and 35 patients(32%) survived to 3 years. The median( IQR) time on VA-ECMO support was 4(3, 5) days. The median( IQR) length of ICU stay and hospital stay duration were 8(5, 12) and 20(13, 29) days, respectively. Older age( HR=1.06, 95% CI: 1.03-1.10, P<0.001), left main coronary artery disease( HR=1.62, 95% CI: 1.00-2.60, P=0.048), and vasoactive inotropic score( HR=1.09, 95% CI: 1.03-1.17, P=0.007)were independent risk factors associated with 3-year mortality. The area under the receiver operating characteristic curve for the model, which was constructed with age≥60years, left main coronary artery disease, and vasoactive inotropic score>60, was 0.88(95% CI: 0.80-0.95). Conclusion:Long-term survival of patients who survive to discharge appears favorable. Older age, left main coronary artery disease, and vasoactive inotropic score were associated with 3-year mortality in coronary artery bypass grafting patients who received VA-ECMO.
