Tracheostomy Practices and Outcomes in Children During Respiratory Extracorporeal Membrane Oxygenation.
Tracheostomy Practices and Outcomes in Children During Respiratory Extracorporeal Membrane Oxygenation.
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DOI：
10.1097/pcc.0000000000002902
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发表时间：
2022-04-01
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接受长期体外膜肺氧合（ECMO）支持的儿童可能受益于ECMO期间的气管切开术，以促进康复;然而，该手术存在风险，特别是出血性并发症。了解ECMO支持的儿童在ECMO上接受气管切开术的气管切开术实践和结局可能会为决策提供信息。回顾性队列研究ECMO中心对2015年1月1日至2019年12月31日期间因呼吸衰竭接受ECMO支持7天或更长时间的18岁以下儿童出生登记的贡献。没有3685名儿童因呼吸衰竭接受至少7天的ECMO支持。ECMO支持的中位持续时间为13.0天（IQR 9.3-19.9），住院死亡率为38.7%（1426/3685）。94/3685例（2.6%）在ECMO支持期间进行了气管造口术。在ECMO上接受气管切开术的患者中，手术在ECMO开始后的中位13.2天（IQR 6.3-25.9）进行。26%的接受气管切开术的儿童（12%在气管切开术放置后）记录了手术部位出血。在接受气管切开术的儿童中，ECMO支持的中位持续时间为24.2天（IQR 13.0-58.7）;住院死亡率为30/94（32%）。在ECMO治疗14天前接受气管切开术的患者年龄较大（中位年龄15.8岁（IQR 4.7-15.5）vs 11.7岁（IQR 11.5-17.3）; p值=0.002），更有可能接受VV-ECMO支持（84% vs 52%，p=0.001）。在14天前接受气管切开术的患者中，22%（11/50）在医院死亡，而在14天或更晚接受气管切开术的患者中，19/44（43%）在医院死亡（p=0.03）。ECMO期间的气管造口术在儿童中并不常见。四分之一接受ECMO气管切开术的患者发生手术部位出血。在14天后进行气管造口术的儿童年龄较小，结局较差，可能代表气管造口术是长期ECMO支持的“次要”策略。
Children receiving prolonged extracorporeal membrane oxygenation (ECMO) support may benefit from tracheostomy during ECMO by facilitating rehabilitation; however the procedure carries risks, especially hemorrhagic complications. Knowledge of tracheostomy practices and outcomes of ECMO-supported children who undergo tracheostomy on ECMO may inform decision-making. Retrospective cohort study ECMO centers contributing to the Extracorporeal Life Support Organization (ELSO) Registry Children birth to 18 years who received ECMO support for 7 days or greater for respiratory failure from January 1st 2015 to December 31st 2019. None 3685 children received at least seven days of ECMO support for respiratory failure. The median duration of ECMO support was 13.0 days (IQR 9.3-19.9), and in-hospital mortality was 38.7% (1426/3685). A tracheostomy was placed during ECMO support in 94/3685 (2.6%). Of those who received a tracheostomy on ECMO, the procedure was performed at a median 13.2 days (IQR 6.3-25.9) after initiation of ECMO. Surgical site bleeding was documented in 26% of children who received a tracheostomy (12% after tracheostomy placement). Among children who received a tracheostomy, the median duration of ECMO support was 24.2 days (IQR 13.0-58.7); in-hospital mortality was 30/94 (32%). Those that received a tracheostomy before 14 days on ECMO were older (median age 15.8 years (IQR 4.7-15.5) versus 11.7 years (IQR 11.5-17.3); p-value=0.002) and more likely to have been supported on VV-ECMO (84% vs 52%, p=0.001). Twenty-two percent (11/50) of those who received a tracheostomy before 14 days died in the hospital, compared to 19/44 (43%) of those who received a tracheostomy at 14 days or later (p=0.03). Tracheostomies during ECMO were uncommon in children. One in four patients who received a tracheostomy on ECMO had surgical site bleeding. Children who had tracheostomies placed after 14 days were younger and had worse outcomes, potentially representing tracheostomy as a “secondary” strategy for prolonged ECMO support.