Predictors and Outcomes of Acute Brain Injury in Patients on Venoarterial Extracorporeal Membrane Oxygenation after Cardiopulmonary Resuscitation.

IF 1.8 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Acta Cardiologica Sinica Pub Date : 2024-01-01 DOI:10.6515/ACS.202401_40(1).20230817B

Chia-Yu Ou, Meng-Ta Tsai, Yi-Chen Wang, Jun-Neng Roan, Chung-Dann Kan, Yu-Ning Hu

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Abstract

Background: Venoarterial (V-A) extracorporeal membrane oxygenation (ECMO) after cardiac arrest often predisposes patients to acute brain injury (ABI), which affects survival and neurological performance. The investigation of the predictors of ABI will be beneficial for further management.

Objectives: To explore the predictors and outcomes of ABI and intracerebral hemorrhage (ICH) in patients experiencing cardiac arrest and cardiopulmonary resuscitation (CPR) with V-A ECMO support.

Methods: We retrospectively analyzed 150 patients who successfully weaned from V-A ECMO support after pre-ECMO CPR at our institution from January 2009 to December 2021. Short-term and long-term outcomes were evaluated. Characteristics before and during ECMO were analyzed for determining the predictors of ABI and ICH.

Results: Of the 150 patients, 66 (44.0%) had ABI. ABI was associated with higher in-hospital mortality (62.1% vs. 21.4%, p < 0.0001) and poorer long-term survival after discharge (p = 0.002). Patients who survived to discharge with ABI had significantly more severe neurological deficits at discharge (84.0% vs. 42.4%, p < 0.0001) and improved little at one year after discharge (33.3% vs. 11.4%, p = 0.027). We found that CPR duration [odds ratio (OR) = 1.04, p = 0.003] was the independent risk factor for ABI, whereas lower platelet counts was the independent risk factor for ICH (OR = 0.96, p = 0.019).

Conclusions: After CPR, development of ABI during V-A ECMO support impacted survival and further neurological outcome. Longer CPR duration before ECMO set up significantly increases the occurrence of ABI. Besides, severe thrombocytopenia during ECMO support increases the possibility of ICH.

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心肺复苏后静脉体外膜氧合患者急性脑损伤的预测因素和预后。

背景：心脏骤停后的体外膜肺氧合（ECMO）患者往往容易发生急性脑损伤（ABI），从而影响存活率和神经功能。研究ABI的预测因素将有利于进一步的管理：目的：探讨心脏骤停患者在 V-A ECMO 支持下进行心肺复苏（CPR）后发生 ABI 和脑内出血（ICH）的预测因素和结果：我们回顾性分析了 2009 年 1 月至 2021 年 12 月期间在我院接受 ECMO 前心肺复苏术后成功脱离 V-A ECMO 支持的 150 例患者。对短期和长期结果进行了评估。分析了 ECMO 之前和期间的特征，以确定 ABI 和 ICH 的预测因素：150名患者中，66人（44.0%）有ABI。ABI 与较高的院内死亡率（62.1% 对 21.4%，p < 0.0001）和较差的出院后长期存活率（p = 0.002）相关。带 ABI 存活出院的患者出院时的神经功能缺损程度明显更严重（84.0% 对 42.4%，p < 0.0001），出院一年后的情况改善甚微（33.3% 对 11.4%，p = 0.027）。我们发现，心肺复苏持续时间[比值比 (OR) = 1.04，p = 0.003]是 ABI 的独立风险因素，而血小板计数较低是 ICH 的独立风险因素（OR = 0.96，p = 0.019）：结论：心肺复苏后，V-A ECMO 支持期间出现 ABI 会影响存活率和进一步的神经功能预后。结论：心肺复苏后，V-A ECMO 支持期间出现 ABI 会影响存活率和进一步的神经功能预后。此外，ECMO 支持期间血小板严重减少也会增加发生 ICH 的可能性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Cardiologica Sinica 医学-心血管系统

CiteScore

2.90

自引率

15.80%

发文量

144

审稿时长

>12 weeks

期刊介绍： Acta Cardiologica Sinica welcomes all the papers in the fields related to cardiovascular medicine including basic research, vascular biology, clinical pharmacology, clinical trial, critical care medicine, coronary artery disease, interventional cardiology, arrythmia and electrophysiology, atherosclerosis, hypertension, cardiomyopathy and heart failure, valvular and structure cardiac disease, pediatric cardiology, cardiovascular surgery, and so on. We received papers from more than 20 countries and areas of the world. Currently, 40% of the papers were submitted to Acta Cardiologica Sinica from Taiwan, 20% from China, and 20% from the other countries and areas in the world. The acceptance rate for publication was around 50% in general.