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Objective:To analyze the status of extracorporeal membrane oxygenation (ECMO) for poisoned patients in China, and prognosis, complications and risk factors for death in poisoned patients supported with ECMO.Methods:The data of adult poisoned patients registered in Chinese Society of Extracorporeal Life Support (CSECLS) database were collected. Patients were divided into the survival group and death group according to the conditions at discharge. The type of poisoning, patient prognosis, hemodynamic parameters and complications before and after ECMO were retrospectively analyzed.Results:A total of 96 poisoned patients supported with ECMO were included in the database from 2017 to 2022, including 77 adult patients. The use of ECMO for poisoning was more common in Henan Province (28 cases, 36%), Guangdong Province (11 cases, 14%) and Zhejiang Province (9 cases, 8%). The number of adult poisoned patients registered in the database increased over time from 2017 to 2022, but the survival rate showed no significant difference ( P = 0.794). Agricultural poisoning was the most common indication (43%). Veno-arterial (V-A) ECMO was used in 60 patients (78%) and venovenous (V-V) ECMO in 27 patients (22%). Thirty-two patients (42%) survived to hospital discharge. The mean duration of ECMO support was 57 (34, 123) h, the mean duration of mechanical ventilation was 88 (33, 211) h, the mean length of hospital stay was 10 (2, 21) days, and the mean length of ICU stay was 9 (2, 18) days. Multivariate analysis showed that 24-h lactic acid level was significantly associated with mortality ( OR = 0.378, 95% CI: 0.183-0.779, P = 0.008). Conclusions:ECMO can be used as a salvage strategy to treat various types of severe poisoning. Although the application of ECMO is expanded rapidly in China, it is still necessary to optimize intervention indications and treatment timing, and adopt standardized ECMO management and monitoring strategies to improve the prognosis of patients.
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Objective To analyze the risk factors and pathogen distribution of nosocomial infection in adult patients undergoing extracorporeal membrane oxygenation (ECMO) after cardiac surgery.Methods The clinical data of 325 patients who underwent ECMO support in the Department of Adult Cardiac Surgery of Beijing Anzhen Hospital from January 2012 to December 2017 were retrospectively analyzed.There were 132 patients with nosocomial infection (infected group) and 193 patients without nosocomial infection (noninfected group).Multivariate logistic analysis was used to analyze the risk factors of nosocomial infection,and the distribution of pathogens in infected patients was also analyzed.Results Among 132 infected patients,67 cases (50.76％) had respiratory infection,40 cases (30.30％) had blood infection,15 cases (11.36％) had surgical wound infection,and 10 cases (7.58％) had urinary tract infection.The case fatality rates of the infected group and non-infected group were 61.37％ (81/132) and 52.85％ (102/ 193),respectively (x2 =6.356,P ＜ 0.05).Univariate analysis showed that long operation time,application of extracorporeal circulation and long-term ECMO support were associated with nosocomial infection.Multivariate logistic regression analysis found that ECMO time (OR =5.565,95％ CI =2.868-10.799,P ＜0.01) was an independent risk factor for nosocomial infection after ECMO treatment in adult patients after cardiac surgery.Among the 132 infected patients,364 strains of pathogens were detected,of which 233 were Gram-negative bacteria,including 79 strains of Acinetobacter Baumann (33.9％) and 32 strains of K.pneumoniae (13.73％);101 strains were Gram-positive bacteria,including Streptococcus aureus (14.85％),Micrococcus (14.85％) and catarrhal bacteria (14.85％);30 strains were fungi and Candida albicans accounted for 70％ of fungi infections.Conclusion The long ECMO support time is an independent risk factor for ECMO-related hospital infections in adult patients undergoing cardiac surgery,and the pathogens are mainly Gram-negative bacteria.