Objective: To explore risk factors associated with in-hospital mortality in patients requiring extracorporeal membrane oxygenation (ECMO) in the perioperative period of heart transplantation. Methods: The data of ECMO cases in the perioperative period of heart transplantation from the Chinese Society of Extracorporeal Life Support (CSECLS) between January 2017 and December 2021 were retrospectively analyzed. These patients were divided into the survival group and non-survival group according to their outcomes at discharge. The demographics, indications and complications of ECMO between the two groups were compared, and the related risk factors of poor prognosis were analyzed. Results: A total of 77 patients were included in the study, including 67 males and 10 females, with a median age [M(Q1, Q3)] of 48 (36, 59) years. Sixty-three patients (81.8%) were successfully withdrawn from the ECMO and 46 patients (59.7%) survived to discharge. The median ECMO time was 139 (92, 253) hours. Compared with the survival group, the non-survival group (n=31) had more patients with chronic kidney disease before surgery [22.6% (7/31) vs 4.3% (2/46), P=0.034], and a higher proportion of continuous renal replacement therapy (CRRT) during ECMO [74.2% (23/31) vs 50.0% (23/46), P=0.034]. Moreover, the non-survival group had longer duration of extracorporeal circulation [262 (195, 312) vs 201 (155, 261) min, P=0.056] and higher lactate value in the first 24 hours of ECMO support [2.7 (2.1, 4.7) vs 2.3 (1.4, 3.8) mmol/L, P=0.060], but the differences were not statistically significant. Multivariate logistic regression analysis showed that perioperative application of CRRT was an independent risk factor for poor prognosis in ECMO patients during heart transplantation (OR=19.345, 95%CI: 1.209-309.440, P=0.036). Conclusion: CRRT treatment during ECMO is a risk factor for in-hospital mortality in patients undergoing heart transplantation.
目的： 探讨心脏移植围手术期应用体外膜氧合（ECMO）辅助患者院内死亡的危险因素。 方法： 回顾性分析2017年1月至2021年12月中国医师协会体外生命支持专业委员会（CSECLS）注册数据库中在心脏移植围手术期应用ECMO辅助的患者临床资料，根据是否存活出院分为存活组与死亡组。对比两组患者基线资料、ECMO应用及并发症发生情况，分析患者院内死亡的相关危险因素。 结果： 共纳入77例患者，男67例，女10例，年龄［M（Q1，Q3）］48（36，59）岁；63例（81.8%）顺利撤机，46例（59.7%）存活出院。ECMO辅助时间139（92，253）h。与存活组相比，死亡组（31例）患者术前合并慢性肾脏病者较多［22.6%（7/31）比4.3%（2/46），P=0.034］，ECMO辅助期间联合应用连续性肾脏替代治疗（CRRT）的比例更高［74.2%（23/31）比50.0%（23/46），P=0.034］；此外，死亡组患者体外循环时间略长［262（195，312）比201（155，261）min，P=0.056］，ECMO辅助首个24 h的乳酸值略高［2.7（2.1，4.7）比2.3（1.4，3.8）mmol/L，P=0.060］，但差异无统计学意义。多因素logistic回归分析结果显示，患者在心脏移植围手术期联合CRRT是院内死亡的危险因素（OR=19.345，95%CI：1.209~309.440，P=0.036）。 结论： 联合CRRT是心脏移植围手术期应用ECMO辅助患者院内死亡的危险因素。.