vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2024-4-100-109vtio-1852Research ArticleТрансплантация сердца и вспомогательное кровообращениеHeart Transplantation and Assisted CirculationТрансплантация сердца у пациентов, перенесших экстракорпоральную сердечно‑легочную реанимацию при интрагоспитальной остановке эффективного кровообращенияHeart transplantation in patients undergoing extracorporeal cardiopulmonary resuscitation in in‑hospital cardiac arrestПопцовВ. Н.PoptsovV. N.

Попцов Виталий Николаевич

123181, Москва, ул. Щукинская, д. 1

Тел. (963) 644-96-39

Vitaliy Poptsov

1, Shchukinskaya str., Moscow, 123182

Phone: (963) 644-96-39

poptsov_vit@mail.ruСпиринаЕ. А.SpirinaE. A.

Москва

Moscow

spirina.ekaterina2011@yandex.ruСолодовниковаА. К.SolodovnikovaA. K.

Москва

Moscow

solodovnikova.nastya20@gmail.comЕпремянА. С.EpremyanA. S.

Москва

Moscow

КузнецоваА. А.KuznetsovaA. A.

Москва

Moscow

hanianya@yandex.ruИгнаткинаА. С.IgnatkinaA. S.

Москва

Moscow

as_ignatkina@mail.ruГлинкинГ. Б.GlinkinG. B.

Москва

Moscow

glebglinkin@yandex.ruБудагаевС. А.BudagaevS. A.

Москва

Moscow

ser.bud.med@gmail.comФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава РоссииРоссияShumakov National Medical Research Center of Transplantology and Artificial OrgansRussian Federation202428082024264100109Copyright © Попцов В.Н., Спирина Е.А., Солодовникова А.К., Епремян А.С., Кузнецова А.А., Игнаткина А.С., Глинкин Г.Б., Будагаев С.А., 20252025Попцов В.Н., Спирина Е.А., Солодовникова А.К., Епремян А.С., Кузнецова А.А., Игнаткина А.С., Глинкин Г.Б., Будагаев С.А.Poptsov V.N., Spirina E.A., Solodovnikova A.K., Epremyan A.S., Kuznetsova A.A., Ignatkina A.S., Glinkin G.B., Budagaev S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1852Цель исследования

Цель исследования: анализ результатов трансплантации сердца у пациентов, перенесших остановку эффективного кровообращения, потребовавшую проведения экстракорпоральной сердечно-легочной реанимации (эСЛР) методом периферической вено-артериальной экстракорпоральной мембранной оксигенации (пВАЭКМО).

Материалы и методы

Материалы и методы. В исследование включили 41 пациента (14 (34,1%) женщин и 27 (65,9%) мужчин, возраст 42,6 ± 16,8 года (40,0 [30,5; 54,0]) с интрагоспитальной остановкой эффективного кровообращения. Причины остановки эффективного кровообращения: острая декомпенсация ХСН (n = 19; 46,3%), необратимая дисфункция сердечного трансплантата (n = 9; 22,0%), посткардиотомная ОСН (n = 5; 12,2%), острый инфаркт миокарда (n = 4; 9,8%), острое отторжение сердечного трансплантата (n = 4; 9,8%).

Результаты

Результаты. Остановка кровообращения у 27 (65,9%) пациентов произошла в ОРИТ, у 14 (34,1%) – вне ОРИТ. Интервал «пункция бедренных сосудов – начало эСЛР» составил 4–17 (9 ± 5) мин, интервал «начало СЛР – пВАЭКМО» – 26 ± 9 мин. У 11 (26,8%) из 41 пациента на фоне ВАЭКМО развилась атоническая кома. У 30 (73,2%) из 41 отсутствовало необратимое повреждение головного мозга. Четыре (9,8%) пациента были выписаны из стационара без неврологических и полиорганных нарушений. У 26 (63,4%) пациентов (10 (38,5%) женщин и 16 (61,5%) мужчин) в возрасте от 14 до 63 лет (40,7 ± 15,8) результатом эСЛР и последующего лечения стало дожитие до трансплантации сердца (ТС) на фоне ВАЭКМО (продолжительность 1–11 (4,0 [1,5; 5,0]) дней). Возраст донора сердца (6 (23,1%) женщин и 20 (76,9%) мужчин) составил 44,0 ± 9,9 года, суммарный балл по шкале Eurotransplant Heart Donor Score – 16,9 ± 2,7, по шкале Donor Risk Index – 6,3 ± 1,5, предполагаемая частота развития тяжелой первичной дисфункции трансплантата (шкала RADIAL) – 15,4 ± 3,7%. Ишемия трансплантата составила 188 ± 72 (170,0 [141,25; 185,0]) мин. У 5 (19,2%) реципиентов развилась тяжелая дисфункция, что потребовало продолжения пВАЭКМО в постперфузионном периоде. Причиной летального исхода (n = 4; 15,3%) в раннем периоде после ТС явилась необратимая полиорганная недостаточность.

Заключение

Заключение. Выживаемость в госпитальном периоде после неотложной ТС у реципиентов, перенесших экстракорпоральную сердечно-легочную реанимацию до трансплантации, составляет 84,7%.

Objective

Objective: to analyze heart transplant (HT) outcomes in patients who suffered cardiac arrest requiring extracorporeal cardiopulmonary resuscitation (ECPR) by peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO).

Materials and methods

Materials and methods. The study included 41 patients (14 (34.1%) women and 27 (65.9%) men, aged 42.6 ± 16.8 (40.0 [30.5; 54.0]) years with in-hospital cardiac arrest. The causes of cardiac arrest were acute decompensated heart failure (n = 19; 46.3%), irreversible graft dysfunction (n = 9; 22.0%), postcardiotomy acute heart failure (n = 5; 12.2%), acute myocardial infarction (n = 4; 9.8%), and acute graft rejection (n = 4; 9.8%).

Results

Results. Twenty-seven (65.9%) patients had cardiac arrest in the intensive care unit (ICU) and 14 (34.1%) outside ICU. The interval between femoral artery puncture and ECPR initiation was 4-17 (9 ± 5) minutes, while that between cardiopulmonary resuscitation (CPR) initiation and peripheral VA-ECMO was 26 ± 9 minutes. Atonic seizure developed in 11 (26.8%) of 41 patients while receiving VA-ECMO. Of the 41 patients, 30 (73.2%) had irreversible brain damage. Four (9.8%) patients were discharged from the hospital without neurological or multiple organ dysfunction. In 26 (63.4%) patients (10 (38.5%) women and 16 (61.5%) men) aged 14 to 63 (40.7 ± 15.8) years, ECPR and subsequent treatment resulted in survival to HT while receiving VA-ECMO (duration 1-11 (4.0 [1.5; 5.0]) days). The age of the heart donor (6 (23.1%) women and 20 (76.9%) men) was 44.0 ± 9.9 years, the cumulative Eurotransplant Heart Donor Score was 16.9 ± 2.7, the Donor Risk Index was 6.3 ± 1.5, and the estimated incidence of severe primary graft dysfunction (RADIAL scale) was 15.4 ± 3.7%. Graft ischemia lasted for 188 ± 72 (170.0 [141.25; 185.0]) minutes. Five (19.2%) recipients developed severe dysfunction, which required continuation of peripheral VA-ECMO in the postperfusion period. The cause of death (n = 4; 15.3%) in the early post-HT period was irreversible multiple organ dysfunction.

Conclusion

Conclusion. In-hospital survival after emergency HT in recipients who underwent ECPR before transplantation is 84.7%.

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The authors declare that there are no conflicts of interest present.