NHẬN XÉT MỘT SỐ YẾU TỐ NGUY CƠ QUÁ TẢI THẤT TRÁI Ở BỆNH NHÂN SỐC TIM ĐƯỢC ĐIỀU TRỊ BẰNG PHƯƠNG PHÁP V-A ECMO

Abstract

Objective: To evaluate the effect of risk factors for the development of left ventricular overload in patients with cardiogenic shock treated with V-A ECMO at the center of critical Care medicine - Bach Mai Hospital. Method: Cohort study of V-A ECMO patients with cardiogenic shock at Bach Mai Hospital ICU from July 2021 to July 2022. Results: A cohort of forty patients was recruited for the study, with 18 male patients (45%) and an average age of 44.0 ± 18.9 years, of whom 17 were diagnosed with myocarditis. The incidence of left ventricular overload in patients diagnosed with myocarditis (64.7%) was higher than that in the non-myocarditis group (26.1%) with a RR of 2.48 (95% CI: 1.15-5.37, p<0.05). ROC curve analysis revealed that admission Troponin T levels were associated with the prediction of left ventricular overload with a sensitivity of 80%, specificity of 62.5%, positive predictive value of 71.4%, and negative predictive value of 72.7% at a cut-off value of 4697.5 ng/L. The area under the curve (AUC) was 0.8 (95% CI: 0.6-1.0, p<0.05). Central venous pressure (CVP) immediately after initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) had a sensitivity of 63.6%, specificity of 83.3%, positive predictive value of 77.8%, and negative predictive value of 65.2% with a cutoff point of 11 mmHg. The area under the curve (AUC) was 0.75 (95% CI: 0.61-0.92, p<0.05). Conclusion: Patients with cardiogenic shock undergoing VA-ECMO who had myocarditis, elevated admission Troponin T levels (≥ 4697.5 ng/L), and elevated post-ECMO CVP (≥ 11 mmHg) were at increased.