Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The In-hospital Clinical Outcomes of Extracorporeal Life Support after Adult Cardiovascular Surgery

성인 심혈관 수술 후 시행한 체외순환보조의 조기 임상결과

  • Yie, Kil-Soo (Department of Thoracic and Cardiovascular Surgery, Kangwon National University Hospital, College of Medicine, Kangwon National University) ;
  • Na, Chan-Young (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Oh, Sam-Sae (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Kim, Jae-Hyun (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Ryu, Se-Min (Department of Thoracic and Cardiovascular Surgery, Kangwon National University Hospital, College of Medicine, Kangwon National University) ;
  • Park, Sung-Min (Department of Thoracic and Cardiovascular Surgery, Kangwon National University Hospital, College of Medicine, Kangwon National University) ;
  • Cho, Seong-Joon (Department of Thoracic and Cardiovascular Surgery, Kangwon National University Hospital, College of Medicine, Kangwon National University)
  • 이길수 (강원대학교 의과대학 흉부외과학교실, 강원대학교병원 임상의학연구소) ;
  • 나찬영 (부천세종병원 흉부외과) ;
  • 오삼세 (부천세종병원 흉부외과) ;
  • 김재현 (부천세종병원 흉부외과) ;
  • 류세민 (강원대학교 의과대학 흉부외과학교실, 강원대학교병원 임상의학연구소) ;
  • 박성민 (강원대학교 의과대학 흉부외과학교실, 강원대학교병원 임상의학연구소) ;
  • 조성준 (강원대학교 의과대학 흉부외과학교실, 강원대학교병원 임상의학연구소)
  • Published : 2009.08.05
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Abstract

Background: We analyzed the clinical results and the factors for survival of patients who underwent extracorporeal life support system after adult cardiovascular surgery. Material and Method: We retrospectively reviewed the medical record of 44 patients (1.6% of the total adult cardiovascular surgical cases) who underwent the use of a ventricular assisted device or extracorporeal membrane oxygenation from January 2002 to August 2008. There were 32 (72.7%) males and their mean age was 61.7$\pm$14.9(range: 20$\sim$73) years old. The mean duration of extracorporeal life support system was 5.3$\pm$3.0 (range: 1$\sim$12) days. Result: Of these 44 patients, 24 (54.5%) patients were successfully weaned from the extracorporeal device. Eighteen (40.9%) survivors were able to be discharged from the hospital. Complications were noted in 38 patients (86.4%). An emergency operation, no usage of a concomitant intraaortic balloon pump and major complications during use of the extra corporeal life support system such as bleeding, flow instability and renal failure were identified as significant risk factors for poor survival on univariated analysis. Owing to educational support and a continuous renal replacement therapy system, the clinical outcomes of these patients have improved since 2006. On multivariated analysis, renal failure and bleeding during extracorporeal life support were significant risk factors for poor survival. Conclusion: Although using. extracorporeal life support systems after adult cardiovascular surgery revealed acceptable clinical results, determining the optimal treatment strategy and further well designed larger studies are needed to improve the survival rate of patients who undergo extracorporeal life support after adult cardiovascular surgery.

배경: 성인 심혈관 수술 이후 체외순환보조를 시행해야 했던 환자들의 조기 임상 성적과 생존에 영향을 미치는 인자 등을 분석하기 위하여 연구를 시행하였다. 대상 및 방법: 2002년 1월 1일부터 2008년 8월 31일 까지 성인 심혈관 수술을 시행 받은 환자 2,721명 중 심실보조장치(Ventricular Assist Device) 혹은 체외막형산화기(Extracorporeal membrane oxygenation)를 삽입한 44명(전체 성인심혈관수술 환자의 1.6%)을 대상으로 수술 및 의무기록지를 후향적으로 분석하였다. 평균 연령은 61.7$\pm$14.9세(범위, 20$\sim$73세)였고 남자가 32명(72.7%)을 차지하였다. 평균 체외순환보조기간은 5.3$\pm$3.0일(범위, 1$\sim$12일)이었다. 결과: 전체 44명의 환자 가운데 체외 순환 보조 장치를 이탈 할 수 있었던 환자는 24명(장치 이탈률 54.5%), 생존퇴원은 18명(생존율 40.9%)이었다. 합병증은 38명(86.4%)에서 발생하였다. 단변량 분석에서, 응급수술, 삽관기간중 출혈, 신부전, 혈류 불안정(flow instability), 대동맥내 풍선장치를 동시에 사용하지 않은 경우 등이 사망에 영향을 미치는 인자로 조사되었고, 2006년 이후 성적이 향상되고 있음을 알 수 있었다. 다변량 분석에서 체외순환중 신부전의 발생, 출혈이 사망에 유의한 인자로 파악되었다. 결론: 성인 심혈관 수술 이후 체외순환보조는 만족할만한 임상결과를 보이고 있어 적극적인 활용이 요구되지만 보다 나은 생존율을 위한 전반적인 치료전략의 개선과 광범위한 전향적인 연구가 필요하다.

Keywords

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