Prognostic factors of patients with coronary heart disease undergoing extra-corporeal membrane oxygenation during perioperative period

Wang Haixia; Zhang Qi; Lu Yonghua; Du Zhongtao; Gao Lei; Hou Xiaotong

doi:10.13498/j.cnki.chin.j.ecc.2025.03.04

Abstract：Objectives To investigate the risk factors of perioperative use of extracorporeal membrane oxygen(ECMO)on prognosis in patients with coronary heart disease.Methods This study retrospectively analyzed the clinical data of patients with coronary heart disease who received ECMO-assisted treatment during perioperative period from the registered database of the Chinese Society of Extracorporeal Life Support from January 2019 to August 2022,and they were divided into death group and survival group according to the outcomes.The baseline data,preoperative and postoperative conditions of ECMO and the occurrence of complications of the two groups were compared,and the risk factors affecting the prognosis of the patients were analyzed.Results A total of 214 patients were enrolled,including 165 males and 71 females,with a median age of 64(58,69)years[M(Q1,Q3)].87 patients survived(41%)and were discharged from hospital,and the average ECMO-assisted time was 89(26,142)h.Among them,175 cases(82%)received CABG during hospitalization,and 39 cases(18%)received PCI.Compared with the survival group,the proportion of patients in the death group(127 cases)who suffered cardiac and respiratory arrest before ECMO assistance and performed external cardiopulmonary resuscitation(ECPR)was higher[37%(47/127)vs.24%(21/87),P=0.047].The lactic acid levels in the death group before and 24 hours after ECMO were higher than those in the survival group[12(7,17)mmol/L vs.8(4,14)mmol/L,P<0.001;8(6,12)mmol/L vs.3(2,4)mmol/L,P<0.001].In addition,IABP assisted time in the survival group was longer than that in the death group[49(9,130)h vs.184(88,273)h,P<0.001].Multiple logistic regression model analysis showed that lactate level at 24 hours after ECMO operation was a risk factor for hospital death(OR=1.391,95%CI:1.219-1.587,P<0.01).Conclusion The proportion of ECPR in the death group is higher,and early microcirculatory failure is associated with poor prognosis.The 24-hour lactate level during ECMO operation is a risk factor for in-hospital mortality,and the use of IABP combined with ECMO assistance may be beneficial for the prognosis of patients.