成人重症敗血症・敗血症ショックに対するV–A ECMOについての後ろ向き研究(Veno–arterial extracorporeal membrane oxygenation for severe sepsis and septic shock in adults: a retrospective study)

要旨 近年，extracorporeal membrane oxygenation（ECMO）の使用が増加してきているが，成人敗血症患者に対するveno–arterial（V–A）ECMOの治療予後についての報告は少ない。今回，The Japan Septic Disseminated Intravascular Coagulation（JSEPTIC DIC）研究の重症敗血症および敗血症ショック患者3,195例の中から，V–A ECMOを導入した30例を対象とし，その予後について検討した。患者背景および併存疾患，重症度，乳酸値，感染部位，感染原因微生物，intra aortic balloon pumping，抗凝固薬，合併症について後ろ向きに解析した。主要評価項目は生存退院率とした。28日生存率は33%，生存退院率は20%であった。生存退院率に関わる予後因子は認めなかった。生存者と死亡者の間に出血性合併症，輸血量に有意差はなかった。本邦での重症敗血症・敗血症ショックに対するV–A ECMOの予後は厳しい結果であった。敗血症患者に対して救命目的にECMOを導入する際には多くの因子を考慮に入れる必要がある。 ABSTRACT Recently, the use of extracorporeal membrane oxygenation (ECMO) has increased, but few studies have reported the outcomes of ECMO for adult patients with sepsis. This study aimed to assess the outcome of veno–arterial (V–A) ECMO in adults with sepsis. Of the 3,195 patients with severe sepsis and septic shock enrolled in the Japan Septic Disseminated Intravascular Coagulation study, we selected 30 patients who received V–A ECMO. We analyzed the patient demographics, comorbidities, acute physiology and chronic health evaluation II score, systemic inflammatory response syndrome score, sequential organ failure assessment score, disseminated intravascular coagulation, lactate levels, infection site, microorganisms, intra aortic balloon pumping, anticoagulant agent and complications. The primary outcome was survival to hospital discharge. The survival rate at day 28 was 33%, and at hospital discharge was 20%. We did not identify prognostic factors associated with survival to hospital discharge. There was no significant difference in bleeding complications and transfusion amounts between survivors and non–survivors. Currently, V–A ECMO use for severe sepsis and septic shock has a poor outcome. Multiple factors must be considered when using ECMO to provide life support to patients with sepsis.