Charakterisierung von Patienten nach Anlage einer extrakorporalen Membranoxygenierung und Evaluation der Lebensqualität der Überlebenden und deren Angehörigen
von Laura Petra Schwarzbauer
Datum der mündl. Prüfung:2023-04-26
Erschienen:2023-04-05
Betreuer:Prof. Dr. Ingo Kutschka
Gutachter:Prof. Dr. Ingo Kutschka
Gutachter:Prof. Dr. Christoph Herrmann-Lingen
Dateien
Name:Dissertation Laura Schwarzbauer.pdf
Size:2.12Mb
Format:PDF
Zusammenfassung
Englisch
Extracorporeal membrane oxygenation is a life-sustaining measure for patients suffering from a heart disease. The heart and lungs are supported by an extracorporeal circulation system. As it is an invasive procedure and the patient is suffering from a serious disease, multiple complications can occur that either make weaning from the extracorporeal membrane oxygenation impossible or lead to death after successful weaning during the subsequent treatment. The survivors´ and their relatives´ quality of life as well as psychological condition are impacted. In this analysis, 119 adult patients that received treatment with extracorporeal membrane oxygenation at the heart, thoracic and vascular surgery department of the medical hospital of the university of Göttingen from the 1st January 2018 to the 31st December 2020 were included. The analyzed collective consists of patients with different indications for extracorporeal membrane therapy. Successful weaning was possible for 58 patients and 24 patients eventually survived the subsequent in-hospital treatment. As it was not possible to wean 61 patients from extracorporeal membrane oxygenation, 95 patients died in total. Parameters possibly predicting weaning or death were identified by comparing different subpopulations. Successfully weaned patients were compared to the patients not possible to wean, and the survivors were compared to the death. Depression and anxiety disorder as pre-existing illness, the implantation of extracorporeal membrane oxygenation in an emergency situation and not during operation as well as extended reanimation before the implantation could negatively influence weaning. During therapy, high blood flow on the 2nd and 3rd day may made weaning impossible and high blood flow on the 2nd day could predict death. Higher lactate on the 1st, 2nd and 3rd day as well as an acidosis on the 1st and 2nd day may had a negative impact on weaning. Death is more likely if there is higher lactate on the 1st, 2nd and 3rd day, reduced pH on the 1st day, higher potassium and lower chloride. Elevated aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase could indicate no weaning and death. Additionally, death could be influenced by lower albumin, higher bilirubin on the 3rd day as well as by higher creatine kinase and creatine kinase-MB. If noradrenaline, levosimendan and tris-buffer-perfusion were given, it was more likely that weaning was impossible. Furthermore, it rather lead to death if adrenaline and tris-buffer-perfusion were administered. The antibiotics meropenem and linezolid may positively influenced weaning, while penicillin rather indicated death. Death could be predicted by the amount of transfusions with platelet concentrate. In contrast, extended stay at the hospital as well as a longer treatment after successful weaning showed that the patient was more likely to survive. The survivors and their relatives were included in a prospective analysis to investigate the impact of extracorporeal membrane oxygenation on their psychological condition as well as on their quality of life. The survey that consisted of standardized questionnaires was answered by 16 patients and 15 relatives. The results showed that both, patients and relatives, had lower quality of life and reduced psychological condition. Especially the patients suffered from distress, had lower resilience and more symptoms of anxiety and depressions. The subjective quality of life was reduced that was confirmed by a low quality-of-life index and experienced impairments. On the other hand, it was shown that the patients received good social support. Similar to the patients, their relatives also had lower quality of life as well as more symptoms of anxiety and depression.
Keywords: extracorporeal membrane oxygenation; weaning; survival; quality of life; psychological outcome