| Objective:This study is divided into two parts,the first part explores the interhospital transfer mode under ECMO support through a retrospective study and summarizes the transfer experience.The second part reviewed and summarized the experience of treating patients with cardiogenic shock under ECMO support,analyzed the patients’ clinical data and laboratory tests,and explored the in-hospital mortality factors of patients with cardiogenic shock under ECMO support.Methods:Part Ⅰ.Retrospective analysis of the clinical data of 46 patients transported by the ECMO team of the First Hospital of Lanzhou University from March 2019 to July2021 under the guidance of the "EFFECT principle",recording and analyzing the patients’ general conditions,ECMO indications,ECMO placement mode,transport mode,interhospital transport distance,transport complications during the transfer,and outcomes.Part ⅡPatients with AMI combined with CS(80 cases)who received ECMO support in the Department of Cardiology of the First Hospital of Lanzhou University from March 2019 to October 2021 were reviewed as study subjects,and were divided into survival and in-hospital death groups according to the in-hospital death status.General information,past medical history,various laboratory test results,and support during ECMO maintenance were collected from the patients for comparison.Risk factors for in-hospital death in CS patients with ECMO support were analyzed.Results:Part ⅠThe mean age of the 46 transported patients was(49±18)years,including 30 males(65.2%);ECMO indications included cardiogenic shock in 35 cases(76.1%),severe respiratory failure in 6 cases(13.0%),and circulatory failure from other causes in 5 cases(10.9%);ECMO was performed in the veno-arterial mode in 40 cases(87.0%)and in the veno-venous mode was used in 40 cases(87.0%)and 6 cases(13.0%).All patients were successfully transported under the guidance of "EFFECT principles" and were transported to our hospital by ambulance,with the longest distance of 1,095 km and the average distance of(267.87±271.05)km.The most common complications during the transfer were fever(9 cases,19.6%)and blood oozing from the cannula(7 cases,15.2%),none of which had serious consequences.The average length of stay was(16±7)d and the average ECMO treatment time was(6±2)d.29cases(63.0%)were discharged alive.Part Ⅱ1.80 patients were included in this study,the average age of all patients was(59±11)years,including 72(90%)males;47 of all patients survived and 33 died,with a survival rate of 59%.2.Patients in the death group had lower blood pressure,lower hemoglobin,lower albumin,and more severe acidosis before ECMO on board(all P < 0.05).3.Patients with invasive ventilator-assisted ventilation,continuous renal replacement treatment(CRRT),poorly improved cardiac ejection fraction,higher norepinephrine dosage and longer ECMO duration during ECMO maintenance had higher mortality(all P < 0.05).4.Binary logistic regression analysis showed that previous coronary artery disease,respiratory failure requiring invasive ventilator support,and renal failure requiring continuous renal replacement therapy were independent risk factors for in-hospital mortality in patients(all P < 0.05).5.A prediction model was developed with risk factors based on the results of regression analysis,and this model was included in the ROC curve for analysis.The results showed that the model predicted in-hospital mortality in patients with CS due to AMI with ECMO support with an AUC = 0.874(95% CI: 0.7978 to 0.9494),and the difference was statistically significant(P < 0.001)Conclusion:1.ECMO-assisted transport is safe and feasible for CS patients.Under the guidance of "EFFECT principle",the transfer is faster and more efficient,and this method is conducive to the rational use of regional medical resources.2.ECMO-assisted CS due to AMI with renal failure,respiratory failure and previous coronary artery disease increases in-hospital mortality. |
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