ABSTRACT
Objective:Early identification of ischemic stroke patients with large vessel occlusion can improve referral efficiency and shorten reperfusion time. The purpose of this study was to analyze the characteristics of patients with large vessel occlusion and identify factors that could predict large vessel occlusion.Methods:The clinical data of 432 patients with ischemic stroke treated through emergency green channel were retrospectively analyzed, and the differences between the large vessel occlusion group (LVO group) and the non-large vessel occlusion group (non-LVO group) were compared, and two independent risk factors of the LVO group were screened out by logistics regression analysis: baseline NIHSS score and D-dimer value. The predicted cutoff values of NIHSS score and D-dimer were further determined by the receiver operating characteristic (ROC) curve.Results:A total of 432 patients with ischemic stroke had complete imaging data, with a mean age of 68.5±12.4 years, including 275 (63.7%) males, and 245 (56.7%) in the LVO group and 187 (43.3%) in the non-LVO group. Age, hemorrhagic transformation, thrombolytic therapy, endovascular treatment, atrial fibrillation, baseline NIHSS score [14.0 (6.0-20.0) vs. 3.0 (1.0-6.0), P<0.05], and D-dimer value at admission [0.9(0.4-2.3) mg/L vs. 0.3 (0.2-0.5)mg/L, P<0.05] were statistically significant different between the two groups. Multivariate Logistic regression analysis showed that higher baseline NIHSS score( OR=1.22,95% CI: 1.17-1.27)and higher D-dimer value( OR=3.10,95% CI: 2.14-4.47)were independent risk factors for large vessel occlusion. Baseline NIHSS score combined with D-dimer value was a good predictor of large vessel occlusion(AUC 0.85 [0.81-0.89]). ROC curve suggested that NIHSS score >6.5 and D-dimer >0.57 mg/L were the cutoff values for predicting large vessel occlusion. Conclusions:Higher baseline NIHSS score and D-dimer value are valuable for early prediction of large vessel occlusion, patients with NIHSS score >6.5 points and D-dimer >0.57 mg/L should be promptly transported to an advanced stroke center for treatment.
ABSTRACT
Objective:To analyze whether lower anticoagulation intensity can reduce the incidence of complications in patients with extracorporeal membrane oxygenation (ECMO).Methods:Clinical data of 88 non-cardiac surgery patients who received ECMO support for more than 72 h were collected in the Extracorpical Life support Center of Jiangsu Province Hospital from March 2015 to March 2021. According to the average activated partial thromboplastin time (APTT) level on the third day of ECMO, the patients were divided into the APTT < 50 s group ( n=53) and APTT ≥50 s group ( n=35). The venovenous ECMO (VV-ECMO) subgroup was divided into the APTT <50 s group ( n=23) and APTT ≥50 s group ( n=10). The venoarterial ECMO (VA-ECMO) subgroup was divided into the APTT <50 s group ( n=30) and APTT≥50 s group ( n=25). The average daily transfusion volume of red blood cells during ECMO, the incidence of bleeding, the incidence of thrombosis and all-cause mortality were compared between the two groups. Results:There were no significant differences in the incidence of thrombosis and all-cause mortality in the APTT <50 s group compared with the APTT ≥50 s group ( P>0.05), but the incidence of bleeding and the daily transfusion volume of red blood cells were significantly decreased (7.5% vs. 35.7%; 0.50 U vs. 0.88 U) ( P < 0.05). In 33 VV-ECMO patients, the all-cause mortality, incidence of bleeding, average daily transfusion volume of red blood cells in the APTT <50 s group were lower than those in the APTT ≥50 s group, and the incidence of thrombosis was higher, but there was no statistical difference between the two groups ( P>0.05). In the 55 VA-ECMO patients, there were no significant differences in all-cause mortality, incidence of bleeding, thrombosis and average daily transfusion volume of red blood cells between the two groups ( P > 0.05). Conclusions:The lower anticoagulation intensity in patients without anticoagulation can reduce the occurrence of bleeding in ECMO patients. It is reasonable for such patients to have a lower anticoagulation intensity and studies with larger sample size need to be carried out.
ABSTRACT
Objective:To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation (ECPR) in the treatment of out-of-hospital cardiac arrest (OHCA) in adults.Methods:The data of 40 adults with OHCA-ECPR in Emergency Department of the First Affiliated Hospital of Nanjing Medical University from April 2015 to April 2022 were retrospectively analyzed. The patients were grouped by discharge survival/in-hospital death, with/without bystander resuscitation, and with/without interhospital transport. Age, sex, Charlson comorbidity index, initial rhythm, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO evacuation success rate, survival rate, ECMO treatment time, time-to-death, and length of hospital stay were analyzed.Results:①Among the 40 patients with OHCA-ECPR, 9 patients (22.5%) survived upon discharge, 7 (77.8%) of whom had good neurological outcomes.②The no-flow time in the survival group was significantly shorter than that in the death group, and the proportion of shockable initial rhythm was higher.③Bystander resuscitation greatly shortened the no-flow time.④The regional OHCA-ECPR interhospital transport extended the CA-Pump On time, without affecting patients’ prognosis.Conclusions:ECPR improves the prognosis of patients with OHCA. Bystander resuscitation greatly shortens the no-flow time. ECPR is significantly effective in patients with short no-flow time and shockable initial rhythm. Regional interhospital transport ECPR is recommended to benefit more patients with OHCA.
ABSTRACT
Objective:To investigate the predictive value of platelet dynamics on the prognosis of 28-day in patients with extracorporeal membrane oxygenation (ECMO).Methods:From January 2017 to December 2020, 60 patients from the Emergency Medicine Center of the First Affiliated Hospital of Nanjing Medical University received ECMO for life support. The baseline data of the patients were collected, the minimum value of platelets on day 1-7 of the machine was calculated, and the platelet change value and change rate were calculated. The patients were divided into the survival group and death group according to the 28-day survival status after ECMO was installed, and the receiver operating curve (ROC) was drawn based on the platelet change value and change rate to evaluate its predictive value for prognosis.Results:Among patients receiving VV-ECMO, the platelet change value and change rate on day 7 had the best prediction effect on the patient's 28-day outcome ( AUCΔPLT7=0.772, P=0.016; AUCΔPLT7%=0.764, P=0.020), when the platelet change value was 4×10 9/L as the critical value, the sensitivity was 0.857, the specificity was 0.615, and when the platelet change rate was -28.99% as the critical value, the sensitivity was 0.857, the specificity was 0.615, and when the platelet change rate was -28.99%. The sensitivity was 0.643 with a specificity of 0.846. In patients receiving VA-ECMO, the platelet change rate on day 6 predicted the best effect on the patient's 28-day outcome ( AUCΔPLT6%= 0.707, P = 0.045). When the platelet change rate was -26.19% as the critical value, the sensitivity was 0.842 and the specificity was 0.643. Conclusions:Platelet dynamic changes of platelets are correlated with the 28-day prognosis of patients receiving ECMO, and the combination of platelet change value and the critical value of change rate can better predict the poor prognosis of patients in both ECMO modes.
ABSTRACT
Objective:To investigate the prognostic value of early lactate in patients with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:A retrospective analysis was performed on the clinical data of patients with ECPR in the Emergency Medicine Department of The First Affiliated Hospital of Nanjing Medical University from March 2015 to August 2021. The age, sex, etiology, initial rhythm, prognosis, blood lactate and pH of patients with ECPR were collected, and their difference between the deceased and survived patients was compared.Results:Totally 95 patients were enrolled, with an average age of 47 years; male accounted for 69.5%, and the survival rate was 29.5%. There was no significant difference in age and sex ratio between the deceased and survived patients. However, the deceased patients had a significant lower rate of shockable rhythms (31.3% vs. 60.8%), a higher level of lactate [16.4 (11.2, 19.1) vs. 9.2 (3.2, 15.0), mmol/L], and a lower pH [7.01 (6.88, 7.23) vs. 7.37 (7.10, 7.43)] than the survived patients. Multivariate binary logistic regression analysis showed that shockable rhythm [odds ratio ( OR) = 0.295, 95% confidence interval ( CI): 0.118-0.739), lactate ( OR=1.159, 95% CI: 1.068-1.258) and pH ( OR= 0.017, 95% CI: 0.002-0.157) were independent risk factors for poor prognosis. Furthermore, a lactate level >24 mmol/L was the best threshold to predict mortality with a specificity of 100%. Combined application, the cutoff point was lactate level>16 mmol/L and pH <6.828. Conclusions:Shockable rhythm, higher early lactate and lower pH value are independent risk factors for prognosis in patients with ECPR. Early lactate > 24 mmol/L or lactate > 16 mmol/L companied with pH < 6.828 are novel indicators of the termination of ECPR.
ABSTRACT
Objective:To investigate the safety of early whole body computed tomography (WBCT) combined with coronary angiography (CAG) in patients with extracorporeal cardiopulmonary resuscitation (ECPR) and its application value in the diagnosis of cardiac arrest and complications of cardiopulmonary resuscitation (CPR).Methods:This was a retrospective study. Patients who underwent ECPR in the Emergency Department of the First Affiliated Hospital of Nanjing Medical University from January 2017 to July 2021 were enrolled in this research. Patients younger than 18 years or with incomplete clinical data were excluded. The results of WBCT and CAG examinations after ECPR were collected.Results:A total of 89 patients with ECPR, aged (47±17) years, were enrolled in the study, all underwent WBCT examination, and no adverse events such as ECMO and tracheal tube shedding occurred. WBCT found 7 cases of pulmonary embolism, 3 cases of aortic dissection and 2 cases of cerebral hemorrhage. WBCT identified CPR-related complications in 42 cases, including rib fractures ( n=20), pneumothorax ( n=5), mediastinal emphysema ( n=5), subcutaneous emphysema ( n=6), and hematoma or swelling at puncture site ( n=6). Fifty-five patients underwent CAG examination, the most common culprit vessels were the left anterior descending branch disease (58.2%) followed by the left circumflex branch disease (27.3%), the right coronary artery disease (21.8%) and left main artery disease (12.7%). Conclusions:Early WBCT and CAG examinations are of great significance and safety for the guidance of treatment in ECPR patients.
ABSTRACT
Objective:To analyze the effectiveness and annual cost-effectiveness of extracorporeal cardiopulmonary resuscitation, ECPR) in adults.Methods:Totally 60 patients received ECPR from April 2015 to March 2020 in Emergency Medicine Department of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The patients were grouped by discharge survival/hospital death and shockable/unshockable initial rhythm. Age, gender, initial rhythm, survival rate, ECMO treatment time, time-to-death, length of stay and hospitalization costs were analyzed. All discharged survivors were followed up for 1 year, then cost-effectiveness analysis was performed using total cost of ECPR as the cost and 1-year survival rate as the effect.Results:Fifty-four adult patients with ECPR were enrolled, and 17 (31.5%) patients survived and discharged, of whom 15 (88.2%) patients had good neurological outcomes and survived at 1-year follow-up. The median ECMO time was 5 ( IQR 1-8) d, time-to-death was 4 ( IQR 1-9) d, length of stay was 10 ( IQR 3-18) d, total hospitalization cost was 209 122 ( IQR 121 431-303 822) RMB, and the daily cost was 23 587 ( IQR 13 439-38 217) RMB. The rate of shockable initial rhythm was significantly higher in the discharge survival group than the hospital death group. The survival rate of ECPR patients with shockable initial rhythm was significantly higher than that of patients with unshockable initial rhythm, and there was no difference in cost. Conclusions:ECPR is a resource-intensive treatment with a total cost of about 200 000 RMB. Moreover, the effectiveness and annual cost-effectiveness are superior for patients with shockable initial rhythm.
ABSTRACT
Objective:To summarize the clinical characteristics and influencing factors on clinical outcome of patients receiving extracorporeal cardiopulmonary resuscitation (ECPR).Methods:A total of 78 patients receiving ECPR admitted to the Department of Emergency Medicine of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People’s Hospital) from March 2015 to December 2020 were retrospectively enrolled. Patients were divided into the survival group and death group according to clinical outcome. Their baseline data, CPR associated parameters, and pre-ECPR laboratory tests were compared between the two groups.Results:Of the 78 included patients, 51 patients were male and 27 female. Twenty-three patients finally survived, including 10 males and 13 females. There were no significant differences in age, body mass index and underlying diseases (hypertension, diabetes and coronary heart disease) between the two groups (all P > 0.05). The proportion of male patients in the survival group was lower than that in the death group ( P=0.017). Meanwhile Survival After Veno-Arterial ECMO (SAVE) score was significantly higher in the survival group than that in the death group[ (-1.57±4.15) vs. (-9.36±5.36), P<0.001]. The proportion of by-stander CPR in the survival group was higher than that in the death group ( P=0.014). The pre-ECPR serum AST, ALT, and Cr levels in the survival group were significantly lower than those in the death group (all P<0.05). Logistic regression analysis showed that by-stander CPR ( OR=0.114, 95% CI: 0.015~0.867, P=0.036) and SAVE score ( OR=0.625, 95% CI: 0.479~0.815, P=0.001) were independent risk factors predicting ICU death in patients receiving ECPR. Conclusions:ECPR is an efficient tool to improve clinical outcomes of patients with cardiac arrest. By-stander CPR and SAVE score are independent risk factors predicting ICU death in patients receiving ECPR.
ABSTRACT
Objective:To analyze the early volume characteristics of patients with severe cardiogenic shock treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and the relationship between their early volume and the prognosis.Methods:This study reviewed patients of Emergency Medical University , treated with VA-ECMO and screened the patients with severe cardiogenic shock and VA-ECMO running more than 72 h for further study. The basic condition of the patients was recorded, and the fluid balance in the first 72 h was analyzed. The patients were grouped according to their fluid balance in the first 72 h. The gender, age, survival rate, continuous renal replacement therapy (CRRT) rate, intra-aortic balloon pump (IABP) rate, and invasive mechanical ventilation rate were compared between the two groups, and the relative risk to the prognosis was calculated. The prognosis was compared between the two groups. Results:Totally 77 patients with severe cardiogenic shock were enrolled. Forty-one cases survived, with an overall survival rate of 53.2%. The volume balance at 48-72 h and the total volume balance at the first 72 h were different between the survival and dead groups. Compared with the positive balance group, patients in the negative balance group were less likely to receive CRRT or invasive mechanical ventilation during the first 72 h. Patients in the negative balance group during the first 72 h had a better survival rate, and their relative risk of survival was 1.81 (95% confidence interval: 1.101, 2.985). However, there was no significant difference in survival rate according to every 24 h fluid balance.Conclusions:Patients with severe cardiogenic shock treated with VA-ECMO who had negative total volume balance during the first 72 h are more likely to survive and less likely to require CRRT or invasive mechanical ventilation.
ABSTRACT
Objective:To study the application of blood products in patients with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and evaluate its effect on the prognosis.Methods:A total of 83 adult patients treated with VA-ECMO in the Emergency Department of the First Affiliated Hospital of Nanjing Medical University from January 2017 to January 2020 were grouped by survival to explore the risk factors of 28-day mortality using binary logistic regression, and the threshold was calculated by ROC curve.Results:Platelet transfusion ( OR=2.506, 95% CI: 1.142-5.499) and non-myocarditis disease ( OR=6.881, 95% CI: 1.615-29.316) were the risk factors of 28-day mortality in adult VA-ECMO patients. The threshold of platelet transfusion was 0.427 mL/(kg·d) (sensitivity 78.4%, specificity 69.6% , AUC 0.735). Conclusions:The increased platelet transfusion is related to the poor prognosis of adult patients with VA-ECMO. Refractory myocarditis patients are better treated with VA-ECMO.
ABSTRACT
Objective:To explore the changing trend of cardiac troponin T (cTnT) in patients with cardiogenic shock (CS) receiving veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and its predictive value.Methods:A retrospective study was conducted. The data of patients with CS receiving V-A ECMO admitted to the First Affiliated Hospital of Nanjing Medical University from March 2015 to May 2020 were enrolled. The baseline data, ECMO related parameters, serum cTnT levels at 1, 2, 3 days after ECMO and intensive care unit (ICU) prognosis were recorded. The parameters with clinical significance and significant difference in univariate analysis were analyzed by binary multivariate Logistic regression analysis. Meanwhile, receiver operating characteristic (ROC) curve was drawn, area under ROC curve (AUC) was analyzed, and the threshold, sensitivity and specificity of serum cTnT level and its reduction rate for predicting clinical outcome were evaluated.Results:A total of 72 patients were enrolled, of which 42 survived and 30 died at ICU discharge, and the ICU mortality was 41.7%. Univariate analysis results: compared with the survival group, the patients in the death group had higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score [32 (30, 34) vs. 29 (25, 30)], and the incidence of cardiac arrest before ECMO (70.0% vs. 31.0%), the ratios of invasive mechanical ventilation and continuous renal replacement therapy during ECMO were higher (96.7% vs. 66.7%, 83.3% vs. 42.9%), and the differences were statistically significant (all P < 0.05). Serum cTnT levels (ng/L) at 2 days and 3 days after ECMO in the death group were significantly higher than those in the survival group [2 days: 6 373.5 (898.3, 15 251.5) vs. 1 760.5 (933.0, 4 257.8), 3 day: 6 202.0 (758.9, 16 554.3) vs. 1 678.0 (623.3, 3 407.8), both P < 0.05], and the decrease rates of cTnT within 2 days and 3 days after ECMO were significantly lower than those in the survival group [2 days: 17.3% (-44.2%, 34.7%) vs. 36.8% (18.1%, 60.6%), 3 days: 32.4% (-30.0%, 55.5%) vs. 53.2% (38.3%, 72.3%), both P < 0.05]. Binary multivariate Logistic regression analysis showed that cardiac arrest before ECMO [odds ratio ( OR) = 4.564, 95% confidence interval (95% CI) was 1.212-17.193, P = 0.025] and the decrease rate of cTnT level within 2 days after ECMO ( OR = 1.617, 95% CI was 1.144-4.847, P = 0.026) were independent prognostic risk factors for the ICU death of CS patients receiving V-A ECMO. ROC curve analysis showed that the decline rate of cTnT within 2 days after ECMO transfer had a certain predictive value for the ICU death of CS patients receiving V-A ECMO. The AUC was 0.704 (95% CI was 0.584-0.824). The optimal diagnostic threshold was 40.0%, the sensitivity was 86.7%, the specificity was 52.4%, the positive predictive value was 66.9%, and the negative predictive value was 89.1%. Conclusions:The early decline rate of cTnT in CS patients who received V-A ECMO treatment in death group was lower than that of survival patients. The cTnT decline rate 2 days after ECMO was an independent risk factor for the death of such patients.
ABSTRACT
Objective:To identify the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on neurological outcome and survival in adults with cardiac arrest (CA).Methods:Totally 31 adult patients with ECPR were enrolled from March 2015 to June 2019 in Emergency Department of the First Affiliated Hospital of Nangjing Medical University (Jiangsu People Hospital). Patients were divided to the survival group ( n=12) and death group ( n=19). Duration of conventional cardiopulmonary resuscitation (CCPR) and extracorporeal membrane oxygenation (ECMO) and other mechanical support were compared between groups. Cerebral performance category (CPC) and hospital survival were also evaluated according to the duration of CCPR before ECPR. Results:The duration of CCPR before ECPR was significantly shorter in the survival group than that in the death group ( P=0.002). Duration of ECMO had no significant difference between the two groups ( P=0.478). The location of CA occurrence had no impact on the hospital survival rate ( P=0.716). ECPR in combination with intra-aortic balloon pump (IABP) also had no impact on the hospital survival rate ( P=0.174), and patients received continuous renal replacement therapy (CRRT) had higher hospital survival than patients without CRRT ( P = 0.032). Patients with CCPR duration ≤ 60 min had higher rates of ROSC and hospital survival ( P <0.001). CPC evaluation showed no difference between the two groups. Conclusions:ECMO can provide effective life support to CA patients, and improve their survival rates. It is recommended to initiation of ECMO implantation within 60 min after CCPR.
ABSTRACT
Objective:To analyze the effect of troponin T decrease rate on the prognosis of patients with acute fulminant myocarditis (AFM) following extracorporeal membrane oxygenation (ECMO).Methods:AFM patients treated with ECMO from April 2015 to December 2018 in our hospital were enrolled in this study. According to the hospital survival, patients were divided into the survival group and non-survival group. The decrease rate of troponin T within 24, 48 and 72 h were compared in the two groups.Results:A total of 18 patients with a mean age of 31 years were enrolled. Fifteen patients survived and 3 patients died with an in-hospital survival rate of 83.3%. The decrease rate of troponin T within 24 h was higher in the survival group than that in the non-survival group (49.36% vs.-59.57%, P<0.05), while there were no statistical differences in 48 h and 72 h between the two groups (57.17% vs.-35.67%, 65.53% vs. 58.96%; all P>0.05). Conclusions:ECMO is an effective treatment for cardiogenic shock or cardiac arrest caused by AFM. The decrease rate of troponin T within 24 h supported by ECMO is higher in the survival group.
ABSTRACT
Objective:To evaluate left ventricular systolic function (LVEF) after extracorporeal membrane oxygenation (ECMO) in patients with acute fulminant myocarditis (AFM).Methods:Seven patients were admitted in the First Affiliated Hospital of Nanjing Medical University from August 2018 to November 2018. All the patients accepted veno-arterial extracorporeal membrane oxygenation (V-AECMO). Complications associated with ECMO and clinical outcome were documented. Transthoracic echocardiography (TTE), single photo emission computed tomography (SPECT), and cardiac magnetic resonance (CMR)were performed to evaluate LVEF.Results:Seven patients were successfully weaned from V-AECMO, 2 of whom had oxygenator leakage, 4 had femoral artery bleeding after decannulation, and 2 had femoral artery pesudoaneurysm. There was no statistical difference in LVEF evaluation between TTE and CMR [(62.4±6.8)% vs (58.9±8.2)%, P >0.05]. CMR and SPECT further revealed myocardial pathological change and coronary arterial blood perfusion. Conclusions:ECMO is recommended in patients with AFM. TTE is simple and easy to perform and is not inferior to CMR in LVEF evaluation. CMR can reflect pathological changes of cardiomyocytes at the cellular level, and SPECT can reflect coronary perfusion.
ABSTRACT
Objective:To explore the predictive factors of renal replacement therapy (RRT) in extracorporeal membrane oxygenation (ECMO) patients.Methods:The clinical data of 68 ECMO patients treated at Emergence Department of Jiangsu Provincial Hospital from January 2015 to December 2018 were retrospectively analyzed. Vasoactive-inotropic score (VIS) was used to assess the usage of vasoactive-inotropic drugs on day 1, 2 and 3 of ECMO (24 h VIS, 48 h VIS, and 72 h VIS). According to received RRT or not, patients were divided into the RRT group and non-RRT group. Age, gender, weight, VIS, presence of cardiac arrest before ECMO, ECMO mode, and ECMO treatment time were compared. Logistic regression analysis was used to identify predictive factors for RRT in ECMO patients.Results:Of the enrolled patients, 73.5% of ECMO patients received RRT. The mean age, 24 h VIS, ECMO failure and mortality of the RRT group were significantly higher than those of the non-RRT group ( P <0.05). The use of RRT was 87.8% in elderly ECMO patients (> cutoff age of 38.5 years). According to the cutoff value of 24 h VIS (33.75), ECMO patients were divided into the high VIS group and low VIS group. The rates of RRT and mortality were both exceeded 90% in the high VIS group, which was significantly higher than that of the low VIS group ( P <0.05). Logistic regression analysis showed that age ( OR=1.223) and 24 h VIS ( OR=1.033) were predictive factors of RRT in ECMO patients ( P <0.05). Conclusions:Age and 24 h VIS show the predictive value for RRT in ECMO patients.
ABSTRACT
Objective:To summarize the inter-hospital transport experience on extracorporeal membrane oxygenation (ECMO) led by a team from emergency department.Methods:The clinical data of 21 patients transferred under the support of ECMO between December 2016 and February 2019 were retrospectively analyzed. All patients were transferred to the First Affiliated Hospital of Nanjing Medical University from other hospitals. Interhospital distance, transport methods, patient demorgraphic characteristics, disease diagnosis, intubation location, intubation method, adverse events during transport and transport outcome were retrieved.Results:Eighteen of the 21 patients were transferred under our mobile ECMO team from outer hospitals to our ECMO intensive care unit. Three patients were cannulated by physicians of outer hospital and transported to our ECMO intensive care unit. All patients were transported by ground ambulance, and the distances varied from 2.5 to 252 km, with an average distance of 112.3±103.2 km. No death occurred during transportation. Adverse events in transport occurred in 6 patients. Of these, the most common were patient-related adverse events..Conclusions:Inter-hospital transport by ECMO in China is currently dominated by ground ambulance.. Experienced mobile ECMO team can safely operate inter-hospital transport supported by ECMO
ABSTRACT
Objective To determine the predictive values of different critical scoring systems for survival rate after discharge in critically ill patients supported by extracorporeal membrane oxygenation (ECMO). Methods The clinical data of 34 critically ill patients supported by ECMO admitted to Department of Emergency of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People's Hospital) from July 2015 to September 2017 were retrospectively analyzed. The general information and the worst values of vital signs and related pathophysiological indicators within 12 hours before ECMO treatment of patients were collected, and sequential organ failure assessment (SOFA), multiple organs dysfunction score (MODS), simplified acute physiology score Ⅱ (SAPSⅡ), and acute physiology and chronic health evaluation Ⅳ(APACHEⅣ) scores were calculated. The patients were divided into survival group and non-survival group according to 28-day survival after hospital discharge. General clinical characteristics and aforementioned scores were compared between the two groups. Scoring systems for predicting prognosis were assessed by using the receiver operating characteristic (ROC) curve. The Kaplan-Meier method was used to depict the surviving curve. Results Thirty-four patients were finally enrolled, 13 of whom were dead at the follow-up period of 28 days after hospital discharge, and 21 survived. Duration of ECMO support in non-survival group was significantly shorter than that in survival group (hours: 101.4±7.8 vs. 134.4±12.6), SOFA, SAPSⅡ, and APACHEⅣ scores were significantly higher than those of survival group (SOFA score: 10.6±3.6 vs. 8.8±3.3, SAPSⅡscore: 38.7±14.3 vs. 31.8±12.5, APACHEⅣ score: 46.5±15.5 vs. 38.1±11.3, all P < 0.05). There was no significant difference in gender, age, body mass index (BMI), vital signs or related pathophysiological indicators within 12 hours before ECMO treatment, or MODS score between the two groups. ROC curve analysis showed that the area under ROC curve (AUC) of SAPSⅡ score for predicting 28-day survival rate was the highest, which was significantly higher than that of SOFA, MODS, and APACHEⅣ score (0.880 vs. 0.694, 0.654, 0.682, all P < 0.05). When the best cut-off value of SAPSⅡ score was 43, the sensitivity was 81.2%, and the specificity was 77.9%. Kaplan-Meier survival analysis showed that 28-day survival rate after hospital discharge in patients with SAPSⅡ score < 43 (n = 18) was significantly higher than that in patients with SAPSⅡ score ≥43 (n = 16; χ2= 2.444, P = 0.018). Conclusions Four critical scoring systems of SOFA, MODS, SAPSⅡand APACHEⅣ have been proved to have good prognostic ability to predict 28-day survival after hospital discharge in critically ill patients supported by ECMO. Among them, SAPSⅡ score system has more accurate prediction value.
ABSTRACT
Objective To summarize the efficacy of extracorporeal membrane oxygenation (ECMO)utilization in Emergency Department (ED),as well as the establishment of emergency ECMO team.Methods A retrospective analysis was carried out in 16 patients treated with ECMO between April 2015 to December 2016 in ED.The clinical data including demographics,diagnosis,initiating ECMO timing,place of ECMO establishment,intubation approaches,duration of ECMO,complications and outcomes were collected and analyzed.Results Eight patients were successfully weaned from ECMO,and 7 of them survived to discharge from hospital.The duration of ECMO support was 4 to 384 hours.The emergency ECMO team was set up.Conclusions Emergency medical team can successfully operate the ECMO process.The emergency medical team-initiated ECMO can provide effectively adjuvant measures to support patients with respiratory failure,circulatory failure and cardiac arrest.
ABSTRACT
@#Objective To explore the effect of Ginsenoside Rgl on glutathion (GSH) level and glutathion peroxidase (GPx) activity after oxygen-glucose deprivation/reperfusion in cultured hippocampal cells. Methods The model of oxygen-glucose deprivation and reperfusion were established with the hippocampal neurons of rats. They were randomly divided into control group, model group and Ginsenoside Rgl treatment groups (5 μmol/L, 20 μmol/L, 60 μmol/L). The GSH level and GPx activity were measured 6 h after reperfusion. The apoptosis and the metabolic rate of methyl thiazolyl tetrazolium (MTT) were detected 24 h after reperfusion. Results Compared with model group, the GSH level, GPx activity, and metabolic rate of MTT improved (P<0.001), and the apoptosis decreased in the Ginsenoside Rgl groups (P<0.001) except with the dosage of 5 μmol/L (P>0.05). Conclusion Ginsenoside Rgl can protect the brain from ischemia by increasing the GSH level and GPx activity.