Mechanical component failures in 28,171 neonatal and pediatric extracorporeal membrane oxygenation courses from 1987 to 2006
Mechanical component failures in 28,171 neonatal and pediatric extracorporeal membrane oxygenation courses from 1987 to 2006
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DOI：
10.1097/pcc.0b013e318198b275
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发表时间：
2009-07-01
影响因子：
4.1
通讯作者：
Annich, Gail M.
中科院分区：
文献类型：
--
作者：
Fleming, Geoffrey M.;Gurney, James G.;Annich, Gail M.
目的：提供与体外膜肺氧合（ECMO）相关的机械组件故障的描述性总结，并检查可能与机械组件故障相关的患者和ECMO变量，并指导进一步研究。我们假设ECMO的持续时间，ECMO的时代，ECMO的适应症，患者的年龄，和中心ECMO体积将与机械组件failure.Design：回顾性队列study.Patients和方法：体外生命支持组织注册表查询所有新生儿和儿科ECMO课程记录。每个ECMO疗程被视为一个独立事件，如果持续时间>= 25小时，并且发生在1987年至2007年之间，则被纳入。持续时间> 458小时或心肺复苏期间有ECMO指征的课程从分析中排除。从体外生命支持组织登记处提取了氧合器、管道、其他管道、猪尾连接器、热交换器和回路中空气的机械部件故障数据。结果：总共纳入了28，171个独立ECMO疗程进行分析，其中14.9%与机械部件故障有关。ECMO持续时间、患者年龄组、ECMO时代和ECMO适应症均与机械组件故障相关。从我们的预测模型中，我们观察到一个连续的非线性关系，这表明随着ECMO支持的持续时间增加，机械组件故障的概率增加。结论：在本研究的过程中，机械组件故障是罕见的新生儿和儿科ECMO，并随着治疗经验的增长而下降。ECMO持续时间的增加与机械部件故障的可能性增加有关。ECMO适应症和患者年龄也与机械组件故障概率有统计学相关性，但ECMO中心容量无关。（Pediatr Crit Care Med 2009;10：439-444）
Objective: To provide a descriptive summary of mechanical component failure associated with extracorporeal membrane oxygenation (ECMO), and to examine patient and ECMO variables that may be associated with mechanical component failure and guide further study. We hypothesized that duration of ECMO, era of ECMO, indication for ECMO, age of patient, and center ECMO volume would be associated with mechanical component failure.Design: Retrospective cohort study.Patients and Methods: Extracorporeal Life Support Organization registry was queried for all neonatal and pediatric ECMO courses recorded. Each ECMO course was treated as an independent event, and was included if duration was >= 25 hrs with occurrence between 1987 and 2007. Courses with a duration > 458 hrs or with an indication for ECMO during cardiopulmonary resuscitation were excluded from analysis. Mechanical component failure data were extracted from the Extracorporeal Life Support Organization registry for the oxygenator, raceway, other tubing, pigtail connectors, heat exchanger, and air in the circuit.Results: A total of 28,171 independent ECMO courses were included for analysis, of which 14.9% were associated with a mechanical component failure. Duration of ECMO, age group of patient, era of ECMO, and indication for ECMO were all associated with mechanical component failure. From our predictive model, we observed a continuous nonlinear relation suggesting increasing probability of mechanical component failure with increasing duration of ECMO support.Conclusions: Mechanical component failure over the course of this study was infrequent during neonatal and pediatric ECMO, and declined across eras as experience with the therapy grew. Increasing duration of ECMO was associated with an increasing probability of mechanical component failure. Indication for ECMO and patient age were also statistically associated with mechanical component failure probability, but ECMO center volume was not. (Pediatr Crit Care Med 2009;10:439-444)