ABSTRACT
Objectives:To analyze the clinical characteristics of patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) and identify the risk factors for death.Methods:The clinical data of 60 patients undergoing ECPR admitted to our hospital and Hangzhou First People's Hospital from September 2014 to September 2019 were retrospectively analyzed. The patients were divided into the survival group and the death group. The clinical data of the two groups were compared to explore the risk factors related to death. COX regression analysis was used to identify the risk factors for death.Results:Sixty patients undergoing ECPR were included in our study, of them, 16 (26.7%) cases were out-of-hospital cardiac arrest (OHCA) and 44 (73.3%) cases were in-hospital cardiac arrest (IHCA). The mortality of OHCA patients was higher than that of IHCA patients (87.5% vs. 56.89%, P < 0.05), and the duration from CPR to ECMO installation in the death group was longer than that in the survival group [(105.4±105.1) min vs. (53.0±28.5) min, P < 0.05]. Compared with the survival group, patients in the death group had higher troponin and glutamic oxalacetic transaminase and lower PH and lactate ( P < 0.05). The median survival time of the 60 patients was 42 days. Out-of-hospital cardiac arrest, high SOFA score before ECMO, high-dose norepinephrine, pulmonary infection during ECMO support and long ECMO support time were independent predictors of patients’ death. Conclusions:Risk factors associated with patients’ death undergoing ECPR are out-of-hospital cardiac arrest, high SOFA score before ECMO, high-dose norepinephrine, long duration from CPR to ECMO installation, pulmonary infection during ECMO support and long ECMO support time.
ABSTRACT
Objective:To compare the treatment effect of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients in the prophylactic distal perfusion catheter (DPC) and the non-prophylactic DPC.Methods:A prospective randomized controlled trial (RCT) was conducted. Patients who received VA-ECMO treatment were reviewed at Affiliated Jinhua Hospital, Zhejiang University School of Medicine from January 2019 to June 2020 were divided into two groups, the prophylactic DPC group (DPC placed immediately after the patient VA-ECMO) and the non-prophylactic DPC group (the DPC was placed after the early limb ischemic signs by using evaluation of the lower extremity perfusion assessment table). Comparing the differences of clinical data of two group patients. Pearson correlation analysis was used to analyze the correlation between peak velocity of dorsalis pedis artery and peak velocity of posterior tibial artery and transcutaneous oxygen partial pressure (TcPO 2). Results:A total of 62 patients were included in the analysis, with 31 cases in prophylactic DPC group and another 31 cases in non-prophylactic DPC group. There were no significant differences in sex, age, body mass index (BMI), smoking index, underlying disease, catheterization site, recovery time before on machine, extracorporeal membrane oxygenation (ECMO) operation time, mechanical ventilation time, length of stay in intensive care unit (ICU), mortality rate in hospital, and acute physiology and chronic health evaluationⅡ(APACHEⅡ) between the preventive DPC group and the non-preventive DPC group. There was no significant difference in ECMO indications, ECMO intubation location and pipeline type. The bleeding in the non-prophylactic DPC group was lower than that in the non-prophylactic DPC group [6.5% (2/31) vs. 29.0% (9/31), P < 0.05]. There were no significant differences in limb complications such as cyanosis, necrosis, amputation, compartment syndrome, arterial thrombosis, vascular reconstruction and repair, pseudoaneurysm, limb ischemic or limb infection. During the ECMO operation, except the blood stream infection in the non-prophylactic DPC group was lower than that in the non-prophylactic DPC group [3.2%(1/31) vs. 19.4% (6/31), P < 0.05], there was no other statistical difference in complications between the two groups. The peak velocity of dorsalis pedis artery in the preventive DPC group was significantly higher than that of the non-preventive DPC group (cm/s: 19.30±10.85 vs. 17.85±8.55, P < 0.05), and the peak velocity of posterior tibial artery was significantly lower than that of the non-preventive DPC group (cm/s: 19.90±10.94 vs. 21.58±9.77, P < 0.05). Pearson correlation analysis showed that the peak velocity of dorsalis pedis artery and peak velocity of posterior tibial artery of the preventive DPC group and the non-preventive DPC group were positively correlated with TcPO 2 ( r values were 0.747, 0.856, 0.850, 0.813, respectively, and P values were all 0.000). Conclusions:For patients with VA-ECMO treatment, the incidence of blood stream infection and bleeding during ECMO operation in non-prophylactic DPC implantation patients is lower than that of prophylactic DPC implantation patients. TcPO 2 is positively correlated with peak velocity of posterior tibial artery and dorsal foot artery in the cannulated limb. In patients with VA-ECMO undergoing femoral artery and vein puncture, in addition to judging the blood supply of lower limbs according to symptoms and signs, ultrasound and TcPO 2 monitoring can also be used as effective monitoring methods.
ABSTRACT
PURPOSE: Regional citrate anticoagulation (RCA) is an attractive anticoagulation mode in continuous renal replacement therapy (CRRT) because it restricts the anticoagulatory effect to the extracorporeal circuit. In recent years, several randomized controlled trials have been conducted to investigate its superiority over other anticoagulation modes. Thus, we performed a systematic review of available evidence on the efficacy and safety of RCA. METHODS: A systematic review of randomized controlled trials investigating the efficacy and safety of RCA was performed. PubMed, Current Contents, CINAHL, and EMBASE databases were searched to identify relevance articles. Data on circuit life span, bleeding events, metabolic derangement, and mortality were abstracted. Mean difference was used for continuous variables, and risk ratio was used for binomial variables. The random effects or fixed effect model was used to combine these data according to heterogeneity. The software Review Manager 5.1 was used for the meta-analysis. RESULTS: Six studies met our inclusion criteria, which involved a total of 658 circuits. In these six studies patients with liver failure or a high risk of bleeding were excluded. The circuit life span in the RCA group was significantly longer than that in the control group, with a mean difference of 23.03 h (95% CI 0.45-45.61 h). RCA was able to reduce the risk of bleeding, with a risk ratio of 0.28 (95% CI 0.15-0.50). Metabolic stability (electrolyte and acid-base stabilities) in performing RCA was comparable to that in other anticoagulation modes, and metabolic derangements (hypernatremia, metabolic alkalosis, and hypocalcemia) could be easily controlled without significant clinical consequences. Two studies compared mortality rate between RCA and control groups, with one reported similar mortality rate and the other reported superiority of RCA over the control group (hazards ratio 0.7). CONCLUSIONS: RCA is effective in maintaining circuit patency and reducing the risk of bleeding, and thus can be recommended for CRRT if and when metabolic monitoring is adequate and the protocol is followed. However, the safety of citrate in patients with liver failure cannot be concluded from current analysis. The metabolic stability can be easily controlled during RCA. Survival benefit from RCA is still controversial due to limited evidence.
Subject(s)
Anticoagulants/therapeutic use , Citrates/therapeutic use , Critical Illness/therapy , Renal Replacement Therapy , Anticoagulants/adverse effects , Blood Coagulation , Citrates/adverse effects , Female , Humans , Intensive Care Units , Male , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
0.05). Conclusion The polymorphism distribution of HLA-B*27 genetic subtypes between unrelated donors and AS patients might have no significant difference.
