Analysis of prognostic factors and nursing strategy of veno-arterial extracorporeal membrane oxygenation
10.3969/j.issn.1008-9691.2024.06.006
- VernacularTitle:静脉-动脉体外膜肺氧合患者预后影响因素分析
- Author:
Jirun CHEN
1
;
Jin QIAN
1
;
Wei PENG
1
;
Kun CHEN
1
Author Information
1. 浙江大学医学院附属金华医院重症医学科,浙江 金华 321000
- Publication Type:Journal Article
- Keywords:
Extracorporeal membrane oxygenation;
Risk factor;
Nursing care;
Retrospective analysis
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2024;31(6):670-675
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the factors influencing the prognosis of patients with veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods A retrospective analysis was conducted on the clinical data of VA-ECMO patients admitted to Affiliated Jinhua Hospital to Zhejiang University School of Medicine from January 2019 to October 2022.The demographic characteristics,previous diseases,and clinical data at the time of extracorporeal membrane oxygenation(ECMO)establishment,such as whether cardiopulmonary resuscitation(CPR)was performed and whether the transfer was from outside the hospital,whether interventional surgery was performed,whether bleeding occurred during VA-ECMO treatment,whether continuous renal replacement therapy(CRRT)was combined,and whether the machine was successfully withdrawn were recorded.Indicators such as albumin(ALB),procalcitonin(PCT),blood lactate acid(Lac),hemoglobin(Hb),and platelet count(PLT)at 24,48,and 72 hours after ECMO establishment were recorded.The ECMO support time,intensive care unit(ICU)stay time,and total hospital stay time were statistically analyzed.The patients were divided into the survival group and the death group based on the prognosis.The differences in the above clinical indicators between the two groups with different prognoses were compared.The indicators with statistically significant differences in the univariate analysis were included in the multivariate COX regression analysis to screen for the risk factors affecting the prognosis of VA-ECMO patients.The receiver operator characteristic curve(ROC curve)was drawn to analyze the predictive value of each risk factor for the prognosis of patients.Results A total of 56 patients were included,among which 37 cases were in the survival group and 19 cases were in the death group.The ECMO support mode was all VA-ECMO.Compared with the survival group,the proportion of combined CRRT and the levels of PCT at 24,48,and 72 hours,48 hours and 72 hours difference,as well as Lac at 48 hours and 72 hours in the death group were significantly increased[the proportion of combined CRRT:78.9%(15/19)vs.35.1%(13/37),PCT(μg/L):24 hours was 26.89(9.51,69.42)vs.3.96(1.83,19.23),48 hours was 32.67(11.37,49.84)vs.4.27(1.08,15.51),72 hours was 24.86(7.73,34.80)vs.2.03(0.62,9.20),48 hours and 72 hours difference was-7.91(-14.91,-2.50)vs.-0.85(-6.17,-0.24);Lac(mmol/L):48 hours was 2.50(1.54,5.70)vs.1.60(1.13,2.79),72 hours was 2.40(1.60,4.90)vs.1.40(0.92,2.54),all P<0.05],while the levels of ALB at 24 hours and 72 hours,Hb at 72 hours,and PLT at 72 hours were significantly decreased[ALB(g/L):24 hours was 26.45±5.08 vs.29.18±2.86,72 hours was 29.06±4.81 vs.31.40±3.67;72 hours was Hb(g/L):90.53±10.84 vs.98.24±13.42,72 hours was PLT(×109/L):38(28,106)vs.100(54,134),all P<0.05],the successful weaning rate was also significantly decreased[52.6%(10/19)vs.89.2%(33/37),P<0.05],and the ECMO support time was significantly prolonged[days:8.0(7.0,11.0)vs.5.0(4.0,8.5),P<0.05].COX regression analysis showed that low ALB at 24 hours after VA-ECMO initiation,high PCT at 24 hours,lower Hb at 72 hours,high Lac at 72 hours,long ECMO support time,combined CRRT during treatment,and failure to successfully wean were independent risk factors affecting the prognosis of patients[relative risk(HR)and 95%confidence interval(95%CI)were 0.819(0.701-0.956),1.028(1.003-1.053),1.069(1.010-1.132),1.859(1.166-2.964),0.819(0.673-0.995),12.925(2.305-72.461),0.040(0.008-0.204),P values were 0.012,0.029,0.022,0.009,0.045,0.004,and 0.000,respectively].ROC curve analysis showed that 24 hours PCT,72 hours Lac,combined CRRT during treatment,and ECMO support time had predictive value for the prognosis of patients,the area under the curve(AUC)was 0.746,0.698,0.719,and 0.703,respectively.The 95%CI was 0.615-0.877,0.554-0.843,0.578-0.860,and 0.566-0.840,respectively.The P values were 0.003,0.016,0.008,and 0.014,respectively.When the cut-off value was 10.03 μg/L,1.55 mmol/L,0.50,5.5 days,the sensitivity were 73.7%,78.9%,78.7%,89.5%,and specificity were 29.7%,45.9%,35.1%,45.9%.Conclusions Low ALB at 24 hours after ECMO establishment,high PCT at 24 hours,low Hb at 72 hours,high Lac at 72 hours,combined CRRT,long ECMO support time,and failure to successfully wean are the related risk factors for the death of VA-ECMO patients.24 hours PCT,72 hours Lac,combined CRRT during treatment,and ECMO support time have predictive value for the prognosis of patients.
