ABSTRACT
Objective·To assess the effect of veno-arterial extracorporeal membrane oxygenation(VA-ECMO)treatment on the mortality rate of patients suffering from cardiogenic shock and cardiac arrest in hospital.Methods·A total of 19 patients with cardiogenic shock or cardiac arrest who were treated with VA-ECMO treatment in Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine from September 2017 to March 2022 were included in the retrospective study.Patients were divided into extracorporeal cardiopulmonary resuscitation(ECPR)group(n=9)and VA-ECMO for cardiogenic shock(E-CS)group(n=10)according to whether cardiac arrest had occurred.The general demographic data,clinical data,Sequential Organ Failure Assessment(SOFA)scores,postoperative complications and prognostic indicators of the two groups of patients were collected.Univariate and multivariate Cox proportional hazard regression analyses were used to evaluate the correlation between each covariate and hospital mortality.Results·Among the included patients,there were 15 males(78.9％),with an average age of 46.5(34.5,61.6)years.The incidence of postoperative complications was as follows:bleeding(47.4％),AKI(36.8％),infection(31.6％),limb ischemia(15.8％)and cerebrovascular accident(5.3％).The duration of VA-ECMO was 4.0(2.0,6.8)days,and the intensive care duration was 11.5(5.8,26.2)days;the ECMO withdrawal success rate was 63.2％,and the hospital mortality was 63.2％.The results of univariate Cox proportional hazard regression analysis showed that AKI(prior to VA-ECMO initiation),postoperative complications of infection and limb ischemia were correlated with the hospital mortality of patients(all P＜0.05).The results of multivariate Cox proportional hazard regression analysis showed that AKI(prior to VA-ECMO initiation),postoperative complications of infection and limb ischemia were also independent risk factors for the hospital mortality of patients(all P＜0.05).Conclusion·For patients with cardiogenic shock and cardiac arrest treated with VA-ECMO,AKI(prior to VA-ECMO initiation),postoperative infection and limb ischemia are independently associated with higher hospital mortality.
ABSTRACT
Objective·To compare the efficacy of video-assisted thoracic surgery (VATS) and conventional lung volume reduction surgery for the treatment of patients with severe chronic obstructive pulmonary disease with a meta-analysis.Methods·Randomized controlled trials (RCT) and non-randomized control studies of VATS (the VATS group) and conventional lung volume reduction surgery (the thoracotomy group) for treating patients with severe chronic obstructive pulmonary disease were collected from databases,including Web of Science,EMbase,PubMed,the Cochrane Library,CNKI,CBM disc,WanFang Data,and VIP.The latest literature was published in November 2016.The assessment included the quality of literature and RevMan5.3 software was used to perform the meta-analysis.Results·Of 779 retrieved articles,12 studies involving 966 patients were included according to the inclusion criteria.The results of meta-analysis showed that the operation time of bilateral LVRS was longer in the VATS group than in the thoracotomy group,but the difference in the operation time of single LVRS between the two groups was not statistically significant.The difference in the duration of chest tube drainage for bilateral LVRS between the two groups was not statistically significant,while the duration of chest tube drainage for single LVRS was significantly shorter in the VATS group than in the thoracotomy group.The amount of intraoperative blood loss postoperative drainage was significantly smaller in the VATS group than in the thoraeotomy group.Postoperative pulmonary function and blood gas analysis showed that the 6 min walking distance was longer in the VATS group than in the thoracotomy group.The differences in FEV1 and PaO2 between the two groups were not statistically significant,as well as the difference in postoperative complications between the two groups.Conclusion·Comparing to conventional lung volume reduction surgery,Video-Assisted thoracic lung volume reduction surgery is a better choice.However,randomized control trials with higher quality and larger scale are required for verification this conclusion due to limitations of the quality and samples of these studies.