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| Effect of transcutaneous oximetry on prognosis of patients with cardiogenic shock receiving extracorporeal membrane oxygenation |
| DONG Liang，LI Lang，ZHANG Xiu-Hong，YAN Zheng，YAN Jie |
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Abstract Objective To evaluate effect of transcutaneous oximetry on prognosis of patients with cardiogenic shock receiving extracorporeal membrane oxygenation (ECMO)．Methods Forty-one patients with cardiogenic shock supported by Veno-Arterial (V-A) ECMO were prospectively enrolled from June 2012 to May 2015. 10 min oxygen challenge test were measured using transcutaneous oximetry at 6 hours after ECMO initiation respectively, 10 min OCT value (10 min OCT) and oxygen challenge index(OCI) were then calculated. Patients were divided into the survival group and the death group based on the 60 days survival status. 10 min OCT, OCI and APACHEⅡ score were compared between groups. The effect of 10 min OCT, OCI and APACHEⅡ score for predicting death was evaluated by receiver operating characteristic (ROC) curves. The surviving curve was created using the Kaplan-Meier method, and the survival of the patients was analyzed by the Log-rank test. Risk factors associated with the prognosis were analyzed using the multiple logistic regression analysis. Results There were 19 patients and 22 patients in survival group and death group respectively. 10 min OCT［(78.00±19.15) mm Hg vs.(55.41±15.68) mm Hg］, OCI［(0.75±0.15) vs.(0.61±0.15)］at 6 h and APACHE Ⅱ score［(11.37±5.54) vs.(19.45±6.47)］were all significantly different between survivors and nonsurvivors (P＜0.05). The area under the ROC curve of 10 min OCT and OCI for predicting death were［(0.82±0.07)95％CI 0.67~0.92］and［(0.75±0.08)95％CI 0.59~0.87］, respectively. The best cutoff point for 10 min OCT was 72.0 mm Hg with a sensitivity of 86.4％and specificity of 73.7％. The best cutoff point for OCI was 0.70 with a sensitivity of 81.8％and specificity of 70.0％. Kaplan-Meier survival analysis indicated that 60 days survival rate of high 10 min OCT and high OCI group were significantly higher than those of low 10 min OCT (66.7％ vs.25.0％, P<0.05) and low OCI (77.8% vs. 21.7%, P<0.05) group. Multivariate logistic regression analysis showed that APACHEⅡ score (OR=1.21, 95％CI 1.08~1.36, P<0.05), 10 min OCT (OR=0.93, 95％CI 0.89~0.97, P<0.05) and OCI (OR=0.002, 95％CI 0.001~0.223, P<0.05) at 6 h were both independent risk factors associated with mortality of cardiogenic shock patients with ECMO. Conclusion Early 10 min OCT and OCI could be used as important indicator for predicting the prognosis of cardiogenic shock patients with ECMO.
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Received: 09 January 2017
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