Characteristics and outcomes of extracorporeal life support in pediatric trauma patients
Characteristics and outcomes of extracorporeal life support in pediatric trauma patients
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DOI：
10.1097/ta.0000000000002712
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发表时间：
2020-10-01
影响因子：
3.4
通讯作者：
Gaines, Barbara A.
中科院分区：
文献类型：
--
作者：
Behr, Christopher A.;Strotmeyer, Stephen J.;Gaines, Barbara A.
背景利用体外膜氧合（ECMO）技术的体外生命支持已用于儿科人群的多种适应症，但其在创伤中的应用尚未得到充分研究。我们试图检查因创伤而接受ECMO的儿童的适应症、特征和结局，并假设结局与因其他适应症而接受ECMO的患者相同。方法：我们对1989年至2018年期间在体外生命支持组织登记处的所有儿科创伤患者进行了回顾性分析。检查患者特征、ECMO适应症、ECMO前后呼吸机设置和血液化学、并发症和存活率。按模式对类别进行分层：静脉-静脉（VV）、静脉-动脉（VA）或转换。数据用SPSS软件进行统计分析，p值小于0.05时认为具有显著性.结果：我们确定了573例患者，中位年龄为4.82岁。大多数患者（62.3%）为男性，接受VA支持（54.5%）。溺水（38.7%）是最常见的机制，其次是烧伤（21.1%）和胸部创伤（17.8%）。并发症发生率高（81.9%），最常见的类型是心血管、机械和出血。并发症的发生率（总体和按类型）与其他外循环生命支持组织队列中报告的并发症相似。总生存率为55.3%，VV组患者的总生存率（74.3%）显著高于VA组患者（41.7%）（p= 0.00），即使在控制机制时也是如此。结论：ECMO治疗小儿创伤患者的生存率和并发症发生率与其他适应症的报道相当。创伤不应被视为ECMO的禁忌症。
BACKGROUND Extracorporeal life support utilizing extracorporeal membrane oxygenation (ECMO) techniques has been used in the pediatric population for numerous indications, but its use in trauma has been understudied. We sought to examine the indications, characteristics, and outcomes of children placed on ECMO for trauma and hypothesized that outcomes would be equivalent to those of patients placed on ECMO for other indications. METHODS We performed a retrospective review of all pediatric trauma patients in the Extracorporeal Life Support Organization registry from 1989 to 2018. Patient characteristics, indications for ECMO, pre- and post-ECMO ventilator settings and blood chemistry, complications, and survival rates were examined. Categories were stratified by mode: venovenous (VV), veno-arterial (VA), or conversion. Data were analyzed using SPSS software, with significance considered atpvalue less than 0.05. RESULTS We identified 573 patients with a median age of 4.82 years. The majority of patients (62.3%) were male and on VA support (54.5%). Drowning (38.7%) was the most common mechanism, followed by burns (21.1%) and thoracic trauma (17.8%). Complication rates were high (81.9%), with the most frequent types being cardiovascular, mechanical, and hemorrhagic. Incidences of complications (overall and by type) were similar to those reported in other Extracorporeal Life Support Organization cohorts. Overall survival was 55.3% and was significantly higher (p= 0.00) for patients on VV (74.3%) compared with those on VA (41.7%), even when controlling for mechanism. CONCLUSION Survival and complication rates of pediatric trauma patients on ECMO are comparable to those reported for other indications. Trauma should not be considered a contraindication for ECMO.