Abstract (German)
Die vorliegende Analyse zeigt mit einer Inzidenz von 18,6%, dass intrazerebrale Komplikationen in dieser Patientengruppe häufig auftreten. Im Rahmen dieser Untersuchung konnten eine Reihe von Faktoren identifiziert werden, welche mit dem Auftreten von intrazerebralen Komplikationen assoziiert sind. Unsere Analyse erlaubt keine Rückschlüsse, inwieweit die Faktoren durch den kritischen ...
Abstract (German)
Die vorliegende Analyse zeigt mit einer Inzidenz von 18,6%, dass intrazerebrale Komplikationen in dieser Patientengruppe häufig auftreten. Im Rahmen dieser Untersuchung konnten eine Reihe von Faktoren identifiziert werden, welche mit dem Auftreten von intrazerebralen Komplikationen assoziiert sind. Unsere Analyse erlaubt keine Rückschlüsse, inwieweit die Faktoren durch den kritischen Gesundheitszustand der Patienten oder wirklich durch die vv-ECMO Therapie bedingt sind. Dennoch erlauben Ergebnisse wie der Einfluss des Gasflusses zwei Stunden nach Beginn der Therapie mittels vv-ECMO, die Thrombozytenzahl und auch die Katecholamindosen mögliche Ansätze für zukünftige prospektive Untersuchungen, mit dem Ziel die Patientenversorgung zu verbessern. Zudem suggerieren unsere Ergebnisse die Notwendigkeit einer zerebralen Überwachung unter vv-ECMO Therapie.
Translation of the abstract (English)
Background: The veno-venous ECMO is established as a treatment option for severe, otherwise untreatable lung failure and used in an increasing number of centers. However, the therapy is associated with complications, especially bleeding and thrombosis.
Methods: In the present study, 290 (n = 290) adult patients from the ECMO register of the Regensburg University Hospital were retrospectively ...
Translation of the abstract (English)
Background: The veno-venous ECMO is established as a treatment option for severe, otherwise untreatable lung failure and used in an increasing number of centers. However, the therapy is associated with complications, especially bleeding and thrombosis.
Methods: In the present study, 290 (n = 290) adult patients from the ECMO register of the Regensburg University Hospital were retrospectively analyzed who received therapy by veno-venous ECMO in the period from 01.01.2007 to 01.11.2015 and received imaging using cCT. The CT examinations were evaluated and the statistical analysis of patient-related, cardiovascular, respiratory-metabolic, hemostaseological and directly ECMO-dependent variables with regard to their significance in terms of the development of pathological intracerebral results during therapy with vv-ECMO.
Results: 290 patients (mean age 49.9 +/- 15.7 years, 72.4% male) received therapy by a vv-ECMO at the Regensburg University Hospital. In 54 of 290 (n = 290) patients a pathological intracerebral finding during the therapy by the vv-ECMO could be demonstrated: 11 patients (3.8%) showed ischemia, 43 patients (14.8%) a hemorrhage. Statistically significant parameters from the group of cardiovascular variables was a higher need for epinephrine two hours after the start of therapy in the group of patients who had cerebral ischemia (odds ratio 158.29, 95% confidence interval 5.21-4813,98, p=0.004). Of the metabolic-respiratory factors in both groups, a lower pH value two hours after the beginning of therapy (ischemia: odds ratio 0.01, 95% confidence interval 0.00-0.57, p=0.027; hemorrhage: odds ratio 0,02, 95% confidence interval 0.00-0.37, p=0.010) a statistical significance can be determined. From the group of hemostaseological parameters, the group of patients who suffered an ischemic cerebral finding during therapy with the vv-ECMO higher D-dimers after three days of therapy statistical significance (odds ratio 1.00, 95% confidence interval 1,00-1.00, p=0.030) can be determined. In the group of patients who suffered hemorrhage during therapy lower platelet counts in the blood before the start of therapy (odds ratio 1.00, 95% confidence interval 0.99-1.00, p=0.003), as well as after three days therapy (odds ratio 0.99, 95% confidence interval 0.99-1.00, p=0.025) were statistically significant for the development of the respective pathological finding. Of the ECMO-associated variables, which can be regulated via the system a higher gas flow two hours after the start of therapy in the group of patients who had an intracerebral hemorrhage during therapy with vv-ECMO showed statistical significance (odds ratio 1.20, 95% confidence interval 1.03-1.39 , p = 0.018). Conclusions: With an incidence of 18.6%, the present analysis shows that intracerebral complications often occur in this patient group. This study identified a number of factors associated with the occurrence of intracerebral complications. Our analysis does not allow any conclusions as to the extent to which the factors are caused by the critical state of health of
the patients or by the vv-ECMO therapy. Nevertheless, results such as the influence of gas flow two hours after the start of therapy with vv-ECMO, the platelet count and also the catecholamine doses allow possible approaches for future prospective studies with the aim of improving patient care. In addition, our results suggest the need for cerebral monitoring under vv-ECMO therapy.
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