切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2021, Vol. 07 ›› Issue (04) : 347 -354. doi: 10.3877/cma.j.issn.2096-1537.2021.04.011

重症医学研究

体外膜肺氧合技术治疗心功能不全的临床评估与荟萃分析
杨飞1, 王少华1, 陈壮1, 石辉1, 隆云2,()   
  1. 1. 024000 内蒙古医科大学赤峰临床医学院 赤峰市医院重症医学科
    2. 100730 中国医学科学院 北京协和医学院 北京协和医院重症医学科
  • 收稿日期:2021-07-28 出版日期:2021-11-28
  • 通信作者: 隆云

Clinical outcomes of heart dysfunction treated by extracorporeal membrane oxygenation (ECMO): a meta-analysis

Fei Yang1, Shaohua Wang1, Zhuang Chen1, Hui Shi1, Yun Long2,()   

  1. 1. Department of Critical Care Medicine, Chifeng Municipal Hospital, Chifeng Clinical Medical School of Inner Mongolia Medical University, Chifeng 024000, China
    2. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2021-07-28 Published:2021-11-28
  • Corresponding author: Yun Long
引用本文:

杨飞, 王少华, 陈壮, 石辉, 隆云. 体外膜肺氧合技术治疗心功能不全的临床评估与荟萃分析[J/OL]. 中华重症医学电子杂志, 2021, 07(04): 347-354.

Fei Yang, Shaohua Wang, Zhuang Chen, Hui Shi, Yun Long. Clinical outcomes of heart dysfunction treated by extracorporeal membrane oxygenation (ECMO): a meta-analysis[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(04): 347-354.

目的

比较经由体外膜肺氧合(ECMO)治疗的心功能不全患者的临床结果。

方法

采用荟萃分析方法,通过计算机检索PubMed、the Cochrane Library、Embase、Web of Science等数据库,纳入符合入排标准的患者接受ECMO治疗的研究文献,检索时限为1970年1月1日至2020年12月31日。所有统计分析均采用Comprehensive Meta-Analysis statistical software,version 2.0软件进行。

结果

一共有18篇文献通过检索并纳入分析,共计729例受试者。荟萃分析显示,心功能不全患者接受ECMO治疗,合并1个月病死率为36.7%(95%CI:0.034~0.905),住院病死率为39.8%(95%CI:0.256~0.560),3个月存活率为72.8%(95%CI:0.621~0.814),6个月存活率为65.4%(95%CI:0.522~0.767),总存活率为67.4%(95%CI:0.485~0.820)。异质性分析显示,纳入的研究之间存在异质性。敏感度分析显示,荟萃分析结果不受个别研究过度影响。纳入文献无明显发表偏倚。

结论

心功能不全患者接受ECMO干预,3个月存活率超过7成,1年存活率超过6成,提示ECMO干预对心功能不全患者有一定的帮助。未来研究须进一步纳入对照性研究,并分析不同的辅助装置是否会对结果产生影响。

Objective

To compare the clinical outcomes of patients with heart dysfunction treated with extracorporeal membrane oxygenation (ECMO).

Methods

PubMed, the Cochrane Library, Embase and Web of Science were searched from January 1, 1970 to December 31, 2020. Statistical analysis were performed using comprehensive meta-analysis statistical software, version 2.0.

Results

After screening for the relevant studies, 18 studies with 729 patients meeting the inclusion criteria were ultimately included. The results of the meta-analysis revealed that in patients with heart dysfunction who received ECMO intervention, the 1-month mortality rate was 36.7% (95%CI: 0.034-0.905), and in-hospital mortality was 39.8% (95%CI: 0.256-0.560). In addition, 3-month survival rate was 72.8% (95%CI: 0.621-0.814), 6-month hospitalization survival rate was 65.4% (95%CI: 0.522-0.767), and overall survival rate was 67.4% (95%CI: 0.485-0.820). Substantial heterogeneity was observed, however, sensitivity analysis showed the combined estimates were robust. No obvious publication bias existed.

Conclusion

The mid-term survival rates of patients with heart dysfunction treating by ECMO are about 60%. Future studies based on controlled trials are warranted. Subgroup analyses by different ventricular assistant device are also suggested.

图1 文献筛选流程图
表1 纳入研究及患者的基本特征信息
研究者 年份 辅助装置 例数 年龄(岁) 男性比例[例(%)] 病死率 生存率
Djordjevic,I 2020 64 63±14 42(68) 1个月病死率88% -
Riebandt,J 2018 左心室辅助 32 52±14 27(84.4) 1个月病死率18.8%,住院病死率25% 1年生存率75%
den Uil,CA 2017 - 29 40±16 12(41) 3个月病死率38% 3个月生存率62%
Fischer,Q 2018 左心室辅助+右心室辅助 44 58.2±12.3 38(86) -

1、3、6个月生存率

88.4%,78.2%,66.1%

Shehab,S 2018 左心室辅助 112 51±14 90(80) - 1年生存率78%
Han,JJ 2018 左心室辅助 18 54±16 14(78) - 1年生存率77%
Leidenfrost,J 2016 左心室辅助+右心室辅助 12 45.6±16 - 1个月病死率8%

3、6个月、1年生存率

86%,63% and 54%

Schoenrath,F 2016 左心室辅助+双心室辅助 57 46.8±15.5 13(43.3) - 1、2、4年生存率6.8%,32.2% and 29.8%
Acheampong,B 2016 24 41(22~75) 14(58.3) 住院病死率54% 住院生存率 46%
Noly,PE 2014 左心室辅助 8 50.8±9.9 5(62.5) 病死率50.00% -
Scherer,M 2011 左心室辅助 10 53±10 9(90) - 总生存率60%
Chou,NK 2010 - 14 - - - 总生存率69.2%
Bautista-Hernandez,V 2009 26 0.12(0~193)* 18(69) - 住院生存率62%
Luo,XJ 2009 45 49.0±14.1 34(76) 住院病死率42% 住院生存率58%
Scherer,M 2009 左心室辅助 5 47±11 4(80) - 总生存率80%
Liu,KS 2009 14 55.7±15.4 7(50) - 住院生存率64%
Taghavi,S 2004 左心室辅助+右心室辅助 13 51.3±15.6 10(77) - 住院生存率43%
Smedira,NG 2001 202 55±14 145(72) - 1个月、1年生存率8%,24%
表2 文献NOS量表评分(分)
图2 患者1个月病死率及住院病死率的荟萃分析。图a为1个月病死率;图b为住院病死率
图3 患者3个月存活率、6个月存活率、1年存活率、住院存活率、总存活率的荟萃分析。图a为3个月存活率;图b为6个月存活率;图c为1年存活率;图d为住院存活率;图e为总存活率
表3 病死率的敏感度分析
表4 存活率的敏感度分析
图4 1年生存率及住院存活率的发表偏倚漏斗图。图a为1年生存率;图b为住院存活率
1
Wang Y, Zhu Z, Xu R, et al. A Complete Occlusion of Right Coronary Artery Due to Stanford Type A Aortic Dissection-Successful Treatment with Extracorporeal Membrane Oxygenation (ECMO) [J]. Braz J Cardiovasc Surg, 2019, 34(4): 491-494.
2
Kelava M, Koprivanac M, Smedira N, et al. Extracorporeal Membrane Oxygenation in Pulmonary Endarterectomy Patients [J]. J Cardiothorac Vasc Anesth, 2019, 33(1): 60-69.
3
Formica F, D'Alessandro S. The right technology for the right ventricular dysfunction: Are we facing the right way [J]? J Thorac Cardiovasc Surg, 2018, 156(6): 2153-2154.
4
Ratnani I, Tuazon D, Zainab A, et al.The Role and Impact of Extracorporeal Membrane Oxygenation in Critical Care [J]. Methodist Debakey Cardiovasc J, 2018, 14(2): 110-119.
5
李呈龙, 侯晓彤, 黑飞龙, 等. 2018中国体外生命支持情况调查分析 [J] . 中华医学杂志, 2019, 99(24): 1911-1915.
6
Sayed S, Schimmer C, Shade I, et al. Combined pulmonary and left ventricular support with veno-pulmonary ECMO and impella 5.0 for cardiogenic shock after coronary surgery [J]. J Cardiothorac Surg, 2017, 12(1): 38.
7
Lepper PM, Hörsch SI, Seiler F, et al. Percutaneous Mechanical Circulation Support Combined with Extracorporeal Membrane Oxygenation (oxyRVAD) in Secondary Right Heart Failure [J]. ASAIO J, 2018, 64(4): e64-e67.
8
Riebandt J, Haberl T, Wiedemann D, et al. Extracorporeal membrane oxygenation support for right ventricular failure after left ventricular assist device implantation [J]. Eur J Cardiothorac Surg, 2018, 53(3): 590-595.
9
Fukushima N, Tatsumi E, Seguchi O, et al. Assessment of Safety and Effectiveness of the Extracorporeal Continuous-Flow Ventricular Assist Device (BR16010) Use as a Bridge-to-Decision Therapy for Severe Heart Failure or Refractory Cardiogenic Shock: Study Protocol for Single-Arm Non-randomized, Uncontrolled, and Investigator-Initiated Clinical Trial [J]. Cardiovasc Drugs Ther, 2018, 32(4): 373-379.
10
Bunge JJH, Caliskan K, Gommers D, et al. Right ventricular dysfunction during acute respiratory distress syndrome and veno-venous extracorporeal membrane oxygenation [J]. J Thorac Dis, 2018, 10(Suppl 5): S674-S682.
11
Riebandt J, Haberl T, Wiedemann D, et al. Extracorporeal membrane oxygenation support for right ventricular failure after left ventricular assist device implantation [J]. Eur J Cardiothorac Surg, 2018, 53(3): 590-595.
12
Leidenfrost J, Prasad S, Itoh A, et al. Right ventricular assist device with membrane oxygenator support for right ventricular failure following implantable left ventricular assist device placement [J]. Eur J Cardiothorac Surg, 2016, 49(1): 73-77.
13
Djordjevic I, Eghbalzadeh K, Sabashnikov A, et al. Single center experience with patients on veno arterial ECMO due to postcardiotomy right ventricular failure [J]. J Card Surg, 2020, 35(1): 83-88.
14
Luo XJ, Wang W, Hu SS, et al. Extracorporeal membrane oxygenation for treatment of cardiac failure in adult patients [J]. Interact Cardiovasc Thorac Surg, 2009, 9(2): 296-300.
15
Acheampong B, Johnson JN, Stulak JM, et al. Postcardiotomy ECMO Support after High-risk Operations in Adult Congenital Heart Disease [J]. Congenit Heart Dis, 2016, 11(6): 751-755.
16
Noly PE, Kirsch M, Quessard A, et al. Temporary right ventricular support following left ventricle assist device implantation: a comparison of two techniques [J]. Interact Cardiovasc Thorac Surg, 2014, 19(1): 49-55.
17
den Uil CA, Jewbali LS, Heeren MJ, et al. Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno-arterial extracorporeal membrane oxygenation [J]. Eur J Heart Fail, 2017, 19 Suppl 2: 104-109.
18
Fischer Q, Kirsch M. Liberal Right Ventricular Assist Device Extracorporeal Membrane Oxygenation Support for Right Ventricular Failure after Implantable Left Ventricular Assist Device Placement [J]. ASAIO J, 2018, 64(6): 741-747.
19
Shehab S, Rao S, Macdonald P, et al. Outcomes of venopulmonary arterial extracorporeal life support as temporary right ventricular support after left ventricular assist implantation [J]. J Thorac Cardiovasc Surg, 2018, 156(6): 2143-2152.
20
Smedira NG, Moazami N, Golding CM, et al. Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: survival at five years [J]. J Thorac Cardiovasc Surg, 2001, 122(1): 92-102.
21
Schoenrath F, Hoch D, Maisano F, et al. Survival, quality of life and impact of right heart failure in patients with acute cardiogenic shock treated with ECMO [J]. Heart Lung, 2016, 45(5): 409-415.
22
Han JJ, Chung J, Chen CW, et al. Different Clinical Course and Complications in Interagency Registry for Mechanically Assisted Circulatory Support 1 (INTERMACS) Patients Managed With or Without Extracorporeal Membrane Oxygenation [J]. ASAIO J, 2018, 64(3): 318-322.
23
Taghavi S, Zuckermann A, Ankersmit J, et al. Extracorporeal membrane oxygenation is superior to right ventricular assist device for acute right ventricular failure after heart transplantation [J]. Ann Thorac Surg, 2004, 78(5): 1644-1649.
24
Bautista-Hernandez V, Thiagarajan RR, Fynn-Thompson F, et al. Preoperative extracorporeal membrane oxygenation as a bridge to cardiac surgery in children with congenital heart disease [J]. Ann Thorac Surg, 2009, 88(4): 1306-1311.
25
Liu KS, Tsai FC, Huang YK, et al. Extracorporeal life support: a simple and effective weapon for postcardiotomy right ventricular failure [J]. Artif Organs, 2009, 33(7): 504-508.
26
Scherer M, Sirat AS, Moritz A, et al. Extracorporeal membrane oxygenation as perioperative right ventricular support in patients with biventricular failure undergoing left ventricular assist device implantation [J]. Eur J Cardiothorac Surg, 2011, 39(6): 939-944; discussion 944.
27
Chou NK, Chi NH, Wu IW, et al. Extracoporeal membrane oxygenation to rescue cardiopulmonary failure after heart transplantation: a single-center experience [J]. Transplant Proc, 2010, 42(3): 943-945.
28
Scherer M, Moritz A, Martens S. The use of extracorporeal membrane oxygenation in patients with therapy refractory cardiogenic shock as a bridge to implantable left ventricular assist device and perioperative right heart support [J]. J Artif Organs, 2009, 12(3): 160-165.
[1] 冯芳, 陈宇, 杨静, 满珂, 蔡红燕, 李群. ω-3鱼油脂肪乳注射液在脓毒症患者中的应用:前瞻性、随机对照、先导试验[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(02): 136-139.
[2] 曹楣汾, 李琼, 凌花, 陆勇, 戴新贵. RETRA评分在ICU收治创伤患者中的应用[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(02): 130-135.
[3] 王柳清, 李萍, 李小石, 刘阳, 吴鹤龄, 周国平. 以头痛、乏力首诊于神经科的鹦鹉热衣原体肺炎二例及文献复习[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(03): 176-181.
[4] 江文诗, 何湘湘. 全球及我国器官捐献发展特征分析与学科建设[J/OL]. 中华移植杂志(电子版), 2023, 17(05): 280-286.
[5] 唐韵, 杨小博, 余愿, 舒化青, 尚游. 苯磺酸瑞马唑仑的临床研究进展[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 389-393.
[6] 黄立, 吴朝, 蔡君婷, 艾宇航, 徐道妙, 刘志勇, 张丽娜. 思政背景下重症医学专业教学实践探讨[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 375-378.
[7] 赵佳钰, 邱英鹏, 刘松桥, 杨毅, 张凌, 于湘友, 秦秉玉, 邱海波, 史黎炜, 刘克军, 蒲莹莹, 陈子扬, 赵羽西, 刘永军, 肖月. 连续性肾脏替代治疗在我国五地区重症医学科的应用现况[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 364-374.
[8] 向阳, 史黎炜, 肖月, 邱海波, 杨毅, 刘松桥, 邱英鹏, 张莹. 连续性肾脏替代治疗在我国五地区重症医学科的效率分析[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 358-363.
[9] 姚庆春, 魏光晨, 孟玫. 关注ICU 患者接受的非必要血液检测[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 329-333.
[10] 周润奭, 郑敏, 韩伟, 李尊柱, 何朝凯, 池熠, 隆云. 目标导向的集束化护理策略对多重耐药菌所致感染性休克患者28 d预后的影响[J/OL]. 中华重症医学电子杂志, 2024, 10(03): 236-242.
[11] 王妍, 李雪珠, 黄力维, 陈辉, 杨毅, 邱海波. 重症医学领域2023年SCI论文研究热点的可视化分析[J/OL]. 中华重症医学电子杂志, 2024, 10(03): 218-226.
[12] 刘付蓉, 翁利, 杜斌. 2020年至2022年中国重症医学临床研究进展[J/OL]. 中华重症医学电子杂志, 2024, 10(01): 48-53.
[13] 黄瑞, 王玉萍, 孙倩, 侯晓红. ICU患者肠内营养并发腹泻最佳证据的审查指标及障碍因素分析[J/OL]. 中华重症医学电子杂志, 2024, 10(01): 38-41.
[14] 中华医学会重症医学分会. 中国成人ICU患者营养评估与监测临床实践指南[J/OL]. 中华重症医学电子杂志, 2023, 09(04): 321-348.
[15] 李琪, 黄钟莹, 袁平, 关振鹏. 基于某三级医院的ICU多重耐药菌医院感染影响因素的分析[J/OL]. 中华临床医师杂志(电子版), 2023, 17(07): 777-782.
阅读次数
全文


摘要