加拿大渥太华大学Shannon M. Fernando团队研究了成人危重症体外膜肺氧合幸存者与新发心理健康诊断的关系。相关论文于2022年10月26日发表在《美国医学会杂志》上。

体外膜肺氧合（ECMO）被用作危重患者的临时心肺支持，但对于ECMO后幸存者的长期精神后遗症知之甚少。为了探讨成年危重病患者ECMO存活率与出院后心理健康诊断的相关性，2010年4月1日至2020年3月31日，研究组在加拿大安大略省进行了一项基于人群的回顾性队列研究，招募≥18岁、入院重症监护病房（ICU）和存活至出院的患者。暴露因素为接受ECMO。

主要结局是出院后新发心理健康诊断（包括情绪障碍、焦虑障碍、创伤后应激障碍、精神分裂症、其他精神病性障碍、其他心理健康障碍和社会问题）。共有8个次要结局，包括药物滥用、故意自残、自杀死亡的发生率，以及复合主要结局的各个组成部分。将患者与未接受ECMO的ICU幸存者进行比较，使用重叠倾向评分-加权原因特定比例风险模型。

在642名接受ECMO的幸存者中（平均年龄50.7岁；女性占40.7%），随访时间中位数为730天；在3820名未接受ECMO的匹配ICU幸存者中（平均年龄51.0岁；40.0%为女性），随访时间中位数为1390天。在接受ECMO的幸存者中，新的心理健康状况发生率为每100人-年22.1例，在非ECMO ICU幸存者中为每100人-年14.5例，绝对率差为7.6例/100人-年。

倾向加权后，ECMO存活率与新发精神健康诊断风险增加显著相关（危险比[HR]为1.24）。在药物滥用方面，接受ECMO的幸存者与未接受ECMO的ICU幸存者之间没有显著差异（分别为1.6例与1.4例/100人-年；HR为0.86）或故意自残（分别为0.4例与0.3例/100人-年；HR为0.68）。在整个队列中，自杀死亡的总病例不到5例。

研究结果表明，在危重病的成年幸存者中，接受ECMO与不接受ECMO的ICU住院相比，与出院后新发精神健康诊断或社会问题诊断的风险略微增加显著相关。

附：英文原文

Title: Association of Extracorporeal Membrane Oxygenation With New Mental Health Diagnoses in Adult Survivors of Critical Illness

Author: Shannon M. Fernando, Mary Scott, Robert Talarico, Eddy Fan, Daniel I. McIsaac, Manish M. Sood, Daniel T. Myran, Margaret S. Herridge, Dale M. Needham, Carol L. Hodgson, Bram Rochwerg, Laveena Munshi, M. Elizabeth Wilcox, O. Joseph Bienvenu, Graeme MacLaren, Robert A. Fowler, Damon C. Scales, Niall D. Ferguson, Alain Combes, Arthur S. Slutsky, Daniel Brodie, Peter Tanuseputro, Kwadwo Kyeremanteng

Issue&Volume: 2022-10-26

Abstract:

Importance  Extracorporeal membrane oxygenation (ECMO) is used as temporary cardiorespiratory support in critically ill patients, but little is known regarding long-term psychiatric sequelae among survivors after ECMO.

Objective  To investigate the association between ECMO survivorship and postdischarge mental health diagnoses among adult survivors of critical illness.

Design, Setting, and Participants  Population-based retrospective cohort study in Ontario, Canada, from April 1, 2010, through March 31, 2020. Adult patients (N=4462; age ≥18 years) admitted to the intensive care unit (ICU), and surviving to hospital discharge were included.

Exposures  Receipt of ECMO.

Main Outcomes and Measures  The primary outcome was a new mental health diagnosis (a composite of mood disorders, anxiety disorders, posttraumatic stress disorder; schizophrenia, other psychotic disorders; other mental health disorders; and social problems) following discharge. There were 8 secondary outcomes including incidence of substance misuse, deliberate self-harm, death by suicide, and individual components of the composite primary outcome. Patients were compared with ICU survivors not receiving ECMO using overlap propensity score–weighted cause-specific proportional hazard models.

Results  Among 642 survivors who received ECMO (mean age, 50.7 years; 40.7% female), median length of follow-up was 730 days; among 3820 matched ICU survivors who did not receive ECMO (mean age, 51.0 years; 40.0% female), median length of follow-up was 1390 days. Incidence of new mental health conditions among survivors who received ECMO was 22.1 per 100-person years (95% confidence interval [CI] 19.5-25.1), and 14.5 per 100-person years (95% CI, 13.8-15.2) among non-ECMO ICU survivors (absolute rate difference of 7.6 per 100-person years [95% CI, 4.7-10.5]). Following propensity weighting, ECMO survivorship was significantly associated with an increased risk of new mental health diagnosis (hazard ratio [HR] 1.24 [95% CI, 1.01-1.52]). There were no significant differences between survivors who received ECMO vs ICU survivors who did not receive ECMO in substance misuse (1.6 [95% CI, 1.1 to 2.4] per 100 person-years vs 1.4 [95% CI, 1.2 to 1.6] per 100 person-years; absolute rate difference, 0.2 per 100 person-years [95% CI, 0.4 to 0.8]; HR, 0.86 [95% CI, 0.48 to 1.53]) or deliberate self-harm (0.4 [95% CI, 0.2 to 0.9] per 100 person-years vs 0.3 [95% CI, 0.2 to 0.3] per 100 person-years; absolute rate difference, 0.1 per 100 person-years [95% CI, 0.2 to 0.4]; HR, 0.68 [95% CI, 0.21 to 2.23]). There were fewer than 5 total cases of death by suicide in the entire cohort.

Conclusions and Relevance  Among adult survivors of critical illness, receipt of ECMO, compared with ICU hospitalization without ECMO, was significantly associated with a modestly increased risk of new mental health diagnosis or social problem diagnosis after discharge. Further research is necessary to elucidate the potential mechanisms underlying this relationship.

DOI: 10.1001/jama.2022.17714

Source: https://jamanetwork.com/journals/jama/fullarticle/2798012