| BackgroundAccording to statistics from the latest statistical research data,cardiovascular disease is currently the most important factor threatening human health worldwide.Its fatality rate is higher than that of tumors and other diseases,and it is becoming younger.With the aging of the population,the incidence of chronic diseases such as diabetes,hypertension,obesity,and hyperlipidemia is on the rise,the number of patients with cardiovascular disease is also increasing,and its prevalence is on the rise.The "Chinese Cardiovascular Disease Report 2018" statistics show that the number of cardiovascular disease(CVD)patients in China is 290 million,of which 11 million are coronary heart disease.In 2016,the death rate of heart disease among rural residents was 151.18/100,000,and the death rate of heart disease in urban areas was 138.70/100,000.It is expected that the number of patients with CVD will continue to grow rapidly in the next 10 years.Among them,acute heart pump failure is the main cause of death from cardiovascular diseases,such as acute myocardial infarction,explosive myocarditis,and acute large-area pulmonary embolism.Once acute heart pump failure occurs,the risk of malignant arrhythmias,cardiac arrest and even sudden death is extremely high,and the mortality rate will increase greatly.It is often difficult for conventional medical treatment to correct or improve the condition of such patients in a timely and effective manner.In recent years,mechanical circulation assistive devices have been increasingly used in cardiovascular critical areas,such as intra-aortic balloon pump(IABP),extracorporeal membrane oxygenation(ECMO),Ventricular assist devices,Impella,etc.ECMO is preferred for its easy availability,simple operation,and relatively low price.It can supply 4-6L of oxygenated blood,which can completely or partially replace the heart function,and mainly plays a bridging role,gaining rescue time for critically ill patients,and seeking follow-up treatment opportunities,thereby improving the survival rate of such patients.After 2016,the number of ECMO applications in China in the field of cardiovascular disease has continued to increase.In 2018,the number of ECMO reported in vitro for life support devices nationwide reached 3923,and continues to grow.With the increasing number of ECMO applications,Its efficacy in different diseases and related risk factors have also been described,but there is no unified conclusion.ObjectiveTo Explore the risk factors influencing ECMO treatment of in-hospital survival in patients with acute heart pump failure.MethodsThirty-two patients with acute cardiac pump failure who underwent ECMO treatment from September 2017 to December 2019 in our cardiac intensive care unit were collected and divided into survival and death groups according to their clinical outcome.Collect general information such as age,gender,comorbidities,basic diseases of the two groups of patients;Cardiopulmonary resuscitation time,recovery to ECMO time,ECMO application time,Changes of blood gas index,hemodynamic detection index,cardiac function and blood biochemical index after ECMO implantation for 24 hours and 48 hours,combination with other mechanical.Then comparing the changes in various indicators between the two groups of clinical data,and analyze the risk factors that affect the hospital death of patients with acute heart pump failure treated by ECMO.Results1.Comparison of general clinical data before ECMO in two groups of patients:there is no difference in the gender,age,comorbidities,past history,and underlying diseases(p>0.05).2.Comparison of postoperative ECMO conditions between the two groups of patients:Compared with the survival group,the cardiopulmonary resuscitation time and the time to rescue ECMO implantation were longer in the death group,and the number of platelets transfused was larger.The difference was statistically significant(p<0.05);there were no significant differences in ECMO support time,the number of combined CRRT cases,the number of combined IABP cases,and the initial ECMO flow,suspended red blood cells infusion,and comparison between the two groups(p>0.05).3.Comparison of various clinical indicators after ECMO support for 48 hours:There was no statistically significant difference in the changes of various indicators during the ECMO period between the two groups of patients(p>0.05);The levels of troponin I,creatine kinase isoenzyme,hemoglobin and platelet in 48 hours after ECMO were significantly lower than those before ECMO(p<0.05);The systolic and diastolic blood pressure of the survival group were higher than that of the death group at 24 and 48 hours after ECMO,and the lactate was lower than that of the death group at the same time(p<0.05);The systolic and diastolic blood pressures in the survival group at 24 and 48 hours after ECMO were higher than before ECMO implantation,and the lactic acid was lower than before ECMO implantation(p<0.05);In the death group,the lactate level of 48 hours after ECMO was lower than that before ECMO,the difference was statistically significant(p<0.05);the other indexes had no statistical significance(p>0.05).4.Analysis of risk factors affecting hospital survival:All the influencing factors of p<0.1 were included in the analysis.Using binary logistic regression analysis,it was found that longer cardiopulmonary resuscitation,time to resuscitation to implantation of ECMO,lactate level at 24h after ECMO,SBP and DBP at 48h after ECMO could affect In-hospital survival,the difference was statistically significant(p<0.05);The factors with statistical significance were analyzed by stepwise backward logistic regression analysis,excluding the influence of other confounding factors.It was found that the longer time of cardiopulmonary resuscitation and the time from resuscitation to ECMO implantation were the risk factors for the survival of patients in hospital,which could increase the risk of death in hospital(p<0.05);The higher level of systolic blood pressure 48h after ECMO can reduce the patient's in-hospital mortality,the difference is statistically significant(p<0.05).Conclusions1.Long time of cardiopulmonary resuscitation and the time from resuscitation to ECMO implantation are closely related to the death of patients in hospital,which can increase the risk of death in hospital and is a risk factor affecting the survival of patients in hospital.2.The higher level of systolic blood pressure 48h after ECMO can reduce the patient's in-hospital mortality.3.Implanting ECMO as early as possible to maintain the patient's hemodynamic stability may improve the patient's in-hospital survival rate. |
PDF Full Text Request