Application And Short-term Prognosis Of Extracorporeal Membrane Oxygenation In Critical Care Patients

ObjectiveThis article is a retrospective study of the case data of patients who were undergoing extracorporeal membrane oxygenation(ECMO)treatment at the First Affiliated Hospital of Zhejiang University School of Medicine from 2011 to 2018,and summarizes relevant clinical experience to analyze the short-term prognostic factors of patients receiving ECMO.And discuss the application of ECMO in new fields such as extracorporeal cardiopulmonary resuscitation(ECPR),perioperative period of cardiopulmonary transplantation,acute poisoning and organ donation.MethodRetrospective analysis of the clinical data and management of patients receiving ECMO at the first hospital affiliated to Zhejiang University Medical College from 2011 to 2018,according to the outcome within 28 days,divided into death group and prognosis group,summarize and explore the treatment of ECMO Machine timing,management in diversion,timing of weaning,and further analysis of prognostic risk factors within 28 days.ResultsA total of 160 patients were enrolled,including 108 males and 52 females.Sixty-nine patients underwent VA(Venous-Artery)mode and 91 patients underwent VV(Venous-Venous)mode.seventy-four of all patients survived,with an overall average survival rate within 7 days was 70.6%,and the average 28-day survival rate was 46.25%.Multiple organ failure was the most common cause of death.univariate Logistic regression analysis showed preoperative APACHE Ⅱ score(OR=1.132,95%CI:1.074-1.194,P<0.001),preoperative lactic acid(Lac)(OR=1.118,95%CI:1.036-1.206,P=0.004),These are positively associated with short-term death and are risk factors for death in hospital;while preoperative mean arterial pressure(MAP)(OR=0.98,95%CI:0.966-0.995,P=0.011),preoperative creatinine(Cr)(OR=1.008,95%CI:1.003-1.0113,P=0.001),establishment of ECMO tubing duration(OR=1.057,95%CI:1.028-1.087,P<0.001),preoperative hemoglobin(Hb)(OR=0.987,95%CI:0.976-0.999,P=0.027),These are negatively correlated with short-term death and are protective factors for death in hospital。ECMO flow time(OR=0.998),95%CI:0.996-0.999,P=0.002),tracheal intubation time(OR=0.998,95%Cl:0.997-0.999,P<0.001),ICU hospitalization time(OR=0.919,95%CI:0.982-0.947,P<0.001),total length of stay(OR=0.893,95%CI:0.861-0.926,P<0.001)may be a risk factor associated with hospital mortality;Multivariate logistic regression analysis showed that the preoperative APACHE Ⅱ score(OR=1.311,95%CI:1.62-1.479,P<0.001)and MAP(OR=1.034,95%CI:1.004-1.065,P=0.024)were corrected under the influence of other factors.establishment of ECMO tubing duration(OR=1.061,95%CI:1.021-1.104,P=0.003),tracheal intubation time(OR=l.002,95%CI:1-1.003,P=0.009),ICU hospitalization time(OR=1.169,95%CI:1.05-1.303,P=0.005),total length of stay(OR=0.705,95%CI:0.613-0.812,P<0.001)is an independent factor related to death in the hospital;Receiver operating characteristic(ROC)curve:The area under the curve of the APACHE Ⅱ score was 0.743(95%confidence interval 0.665-0.82)and the cut-off value was 22(sensitivity was 59.30%;specificity was 82.43%;Youden index was 41.735);The area under the curve of the anterior mean arterial blood pressure was 0.613(95%confidence interval 0.526-0.701)and the cut-off value was 63(sensitivity was 28.235%;specificity was 90.541%;Youden index was 18.776);The area under the curve of establishment of ECMO tubing duration of ECMO pipeline duration was established.the 0.717(95%confidence interval 0.638-0.796)and the cut-off value is 48(sensitivity is 46.512%;specificity is 89.189%;Youden index is 35.701);the area under the curve of tracheal intubation time is 0.701(95%)Confidence interval 0.618-0.783)and cut-off value 672(sensitivity is 93.023%;specificity is 41.892%;Youden index is 34.915);area under ICU hospitalization curve is 0.819(95%confidence interval 0.756-0.883)and criticality The value was 26(sensitivity is 90.698%;specificity is 58.108%;Youden index is 48.806);the area under the curve of total hospital stay was 0.885(95%confidence interval 0.836-0.934)and the cut-off value was 28(sensitivity is 91.86%;specificity is 68.919%;Youden index is 60.779)It is);With death as the end point event,according to the constant censoring at different times,the COX survival function curve is drawn.The curve shows a gradual decline trend,and it is continuously censored in the first 10 days,which more intuitively reflects each time point.Survival probability.ConclusionECMO is an important tool for saving life in critically ill patients.It can effectively substitute cardiopulmonary function in patients with cardiopulmonary failure who may be cured after effective treatment and make patients pass the fatal dangerous period.It plays an important role in the rescue treatment of critically ill patients.The prime timing of conducting ECMO is the key.In this study,the preoperative APACHE Ⅱ score,MAP,duration of ECMO tubing,tracheal intubation time,ICU hospitalization,and total length of stay were independent factors associated with in-hospital death,In the clinical work,the short-term prognosis of patients can be estimated according to these indicators.According to the statistical results of the area under the ROC curve,the total hospitalization time has a higher predictive value for ECMO patients,followed by ICU hospitalization time;and preoperative MAP to ECMO The treatment of patients has little predictive value.With the expansion of ECMO indications,it is not only applied well in the field of severe ARDS and circulatory failure,but also made major breakthroughs in ECPR,perioperative period of cardiopulmonary transplantation,acute poisoning and organ donation.