Cardiac ECMO for biventricular hearts after paediatric open heart surgery
Cardiac ECMO for biventricular hearts after paediatric open heart surgery
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DOI：
10.1136/hrt.2002.003509
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发表时间：
2004-05-01
期刊：
影响因子：
5.7
通讯作者：
Goldman, AP
中科院分区：
文献类型：
--
作者：
Chaturvedi, RR;Macrae, D;Goldman, AP
目的：描述一个大系列的双心室生理支持与体外膜肺氧合（ECMO）的儿童心脏直视手术后的医院生存率的预测因素。结果：81名儿童心脏直视手术后被放置在ECMO。58%（47/81）的患者直接从体外循环转至ECMO。住院存活率为49%（40/81），但这些幸存者中有7例晚期死亡（18%）。提高生存率的因素是在手术室开始ECMO（64%的生存率（30/47）），而不是在心脏重症监护室（29%的生存率（10/34））和开始ECMO治疗反应性肺动脉高压。医院生存的重要不利因素是严重的机械ECMO电路的问题，肾支持，残留病变，和ECMO.Conclusions的持续时间：医院生存的儿童与双心室生理谁需要心脏ECMO是类似的系列中发现，包括单心室心脏，这表明成功的心脏ECMO是严重依赖于识别心脏可逆性心室功能障碍。在我们的术后心脏ECMO经验中，手术室插管患者的生存率高于心脏重症监护室，这是由于早期有效的支持，防止了长时间的低灌注和避免了灾难性的心脏骤停。
Objective: To delineate predictors of hospital survival in a large series of children with biventricular physiology supported with extracorporeal membrane oxygenation ( ECMO) after open heart surgery.Results: 81 children were placed on ECMO after open heart surgery. 58% ( 47 of 81) were transferred directly from cardiopulmonary bypass to ECMO. Hospital survival was 49% ( 40 of 81) but there were seven late deaths among these survivors (18%). Factors that improved the odds of survival were initiation of ECMO in theatre (64% survival ( 30 of 47)) rather than the cardiac intensive care unit (29% survival ( 10 of 34)) and initiation of ECMO for reactive pulmonary hypertension. Important adverse factors for hospital survival were serious mechanical ECMO circuit problems, renal support, residual lesions, and duration of ECMO.Conclusions: Hospital survival of children with biventricular physiology who require cardiac ECMO is similar to that found in series that include univentricular hearts, suggesting that successful cardiac ECMO is critically dependent on the identification of hearts with reversible ventricular dysfunction. In our experience of postoperative cardiac ECMO, the higher survival of patients cannulated in the operating room than in the cardiac intensive care unit is due to early effective support preventing prolonged hypoperfusion and the avoidance of a catastrophic cardiac arrest.