中国体外生命支持2025，Vol.23Issue(6)：509-514,6.DOI:10.13498/j.cnki.chin.j.ecls.2025.06.07
重症心源性休克患者应用静脉-动脉体外膜氧合早期撤机的相关危险因素
Early Weaning Associated Risk Factors in Patients With Severe Cardiogenic Shock Treated With Veno-Arterial Extracorporeal Membrane Oxygenation
摘要
Abstract
Objective To investigate the early weaning success rate of veno-arterial extracorporeal membrane oxygenation(V-A ECMO)in patients with severe cardiogenic shock(CS)and to identify relevant clinical and laboratory risk factors,aiming to provide evi-dence for timely weaning decisions and individualized management.Methods This retrospective study included 83 patients with severe CS who received V-A ECMO support at our hospital between January 2023 and December 2024.All patients met the inclusion criteria.According to whether ECMO was successfully weaned within 7 days after initiation,patients were divided into an early weaning success group(n=34)and a failure group(n=49).Data collected included demographic information,comorbidities,SOFA score,laboratory pa-rameters before ECMO and at 24 hours post-initiation(lactate,troponin I,NT-proBNP,D-dimer,platelet count,etc.),echocardiographic parameters(LVEF,LVOT VTI),ECMO-related parameters(pump speed,flow rate),additional support(IABP,CRRT),and ECMO-related complications(bleeding,infection,limb ischemia,etc.).Group comparisons were performed using t-tests,Mann-Whitney U tests,and χ2 tests.Multivariate logistic regression was used to identify independent predictors of early weaning success,and model performance was assessed using receiver operating characteristic(ROC)curves.Results The early weaning success rate among patients receiving V-A ECMO was 40.96%(34/83).Univariate analysis revealed that compared to the failure group,the success group had significantly lower pre-ECMO lactate levels(3.74±1.19 mmol/L vs.6.21±2.05 mmol/L,P<0.001),significantly higher lactate clearance 24-hour post-ini-tiation(61.35%±12.28%vs.38.67%±11.46%,P<0.001),higher LVEF(37.82%±5.41%vs.29.47%±6.33%,P<0.001),greater LVOT VTI(14.26±3.51 cm vs.10.72±2.86 cm,P<0.001),higher platelet count(132.58±37.92×109/L vs.95.46±29.13×109/L,P=0.003),and higher urine output(876.41±265.32 mL/d vs.523.17±218.49 mL/d,P=0.008),while D-dimer levels were significant-ly lower in the success group(2.64±0.85 mg/L vs.4.13±1.26 mg/L,P=0.002).Multivariate logistic regression identified pre-ECMO lactate level(OR=1.92,95%CI:1.31-2.85,P=0.001),lactate clearance rate(OR=0.76,95%CI:0.65-0.89,P<0.001),LVEF(OR=0.81,95%CI:0.70-0.94,P=0.005),and D-dimer level(OR=1.48,95%CI:1.11-1.97,P=0.009)as independent risk factors for early weaning failure.The ROC curve demonstrated strong predictive performance of the model,with an AUC of 0.871(95%CI:0.793-0.934),sensitivity of 85.29%,and specificity of 82.35%.Conclusion The early weaning success rate for patients with severe CS supported by V-A ECMO remains relatively low at approximately 40.96%.Elevated lactate and D-dimer levels,along with reduced lactate clearance and impaired cardiac function(as indicated by LVEF),are significantly associated with early weaning failure.Comprehensive and dynamic evaluation of metabolic status and cardiac function is essential to optimize weaning timing,improve clinical outcomes,and reduce complications in patients receiving ECMO support.关键词
体外膜氧合/心源性休克/早期撤机/危险因素/管理策略Key words
extracorporeal membrane oxygenation/cardiogenic shock/early weaning/risk factors/management strategy引用本文复制引用
WU Chan,TANG Shengyu,CHEN Yang,TANG Taotao..重症心源性休克患者应用静脉-动脉体外膜氧合早期撤机的相关危险因素[J].中国体外生命支持,2025,23(6):509-514,6.基金项目
四川省医学会(青年创新)科研项目(S22013) （青年创新）
