医学
心源性休克
体外膜肺氧合
倾向得分匹配
复苏
休克(循环)
逻辑回归
内科学
心肺复苏术
心脏病学
存活率
麻醉
心肌梗塞
作者
Wulfran Bougouin,Nadia Aïssaoui,Alain Combes,Nicolas Deye,Lionel Lamhaut,Daniel Jost,Carole Maupain,Frankie Beganton,Adrien Bouglé,Nicole Karam,Florence Dumas,Éloi Marijon,Xavier Jouven,Alain Cariou
出处
期刊:Resuscitation
[Elsevier]
日期:2017-01-01
卷期号:110: 126-132
被引量:34
标识
DOI:10.1016/j.resuscitation.2016.11.005
摘要
Purpose Cardiogenic shock due to post-resuscitation myocardial dysfunction is a major cause of mortality among patients hospitalized after cardiac arrest (CA). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been proposed in the most severe cases but the level of evidence is very low. We assessed characteristics, outcome and prognostic factors of patients treated with VA-ECMO for post-CA shock. Methods Using a large regional registry, we focused on all CA admitted in ICU. Among those who developed a post-CA shock, prognostic was compared according to VA-ECMO use, using logistic regression and propensity score. Specific prognostic factors were identified among VA-ECMO patients. Results Among 2988 patients admitted after CA, 1489 developed a post-CA shock, and were included. They were mostly male (68%), with mean age 63 years (SD = 15). Fiflty-two patients (3.5%) were treated with VA-ECMO, mostly patients with ischemic cause of CA (67%). Among patients with post-CA shock, 312 (21%) were discharged alive (25% in VA-ECMO group, 21% in control group, P = 0.45). After adjustment for pre-hospital and in-hospital factors, survival did not differ among patients treated with VA-ECMO (OR for survival = 0.9, 95%CI 0.4–2.3, P = 0.84). After propensity-score matching, results were consistent. Among patients treated with VA-ECMO, initial arterial pH (OR = 1.7 per 0.1 increase, 95%CI 1.0–2.8, P = 0.04) and implantation of VA-ECMO over 24 h after ROSC (OR = 20.0, 95%CI 1.4–277.3, P = 0.03) were associated with survival. Conclusions Post-CA shock is frequent and is associated with a high mortality rate. When used in selected patients, we observed that VA-ECMO could be an appropriate treatment.
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