Pediatric cardiac surgical ECMO: multivariate analysis of risk factors for hospital death.
Pediatric cardiac surgical ECMO: multivariate analysis of risk factors for hospital death.
复制标题
DOI：
10.1016/0003-4975(95)00410-m
复制
发表时间：
1995-08
期刊：
影响因子：
--
通讯作者：
Henry Lane Walters;M. Hakimi;M. D. Rice;Juanita M. Lyons;G. Whittlesey;M. Klein
中科院分区：
文献类型：
--
作者：
Henry Lane Walters;M. Hakimi;M. D. Rice;Juanita M. Lyons;G. Whittlesey;M. Klein
基础体外膜肺氧合（ECMO）已成为一种有效的技术，为许多儿科心脏切开术后的患者与医学难治性heartfailure. METHODS的机械支持，我们回顾性地审查了73例先天性心脏病患儿的记录，他们被放置在1984年8月和1994年2月之间的ECMO支持。根据ECMO插管相对于手术时间的时间将患者分组。第1组患者（n = 7，9.6%）术前接受ECMO。第2组患者（n = 66，90.4%）是心脏修复后任何时间间隔接受ECMO的异质人群。亚组2A包括无法脱离体外循环并在修复后立即转换为ECMO支持的患者（n = 17，25.8%）。亚组2B患者（n = 49，74.2%）在术后临床稳定期后插管。所有研究患者（42/73）和组2患者（38/66）的住院生存率为58%。与2B组34例患者（69.4%）相比，2A组仅4例患者（23.5%）在住院期间存活（p = 0.001）。多变量分析确定ECMO拔管后右心房压力升高（p = 0.049），并可能，在组2A（p = 0.061）的成员资格作为独立的危险因素，医院death. CONCLUSIONSExtracardiomembrane氧合是最有效的抢救儿科心脏手术患者证明，在一定的时间间隔后，成功地脱离体外循环的医学难治性血流动力学恶化。体外膜氧合拔管后右心房压力是院内死亡的独立预测因子。
BACKGROUNDExtracorporeal membrane oxygenation (ECMO) has emerged as an effective technique for the mechanical support of many pediatric postcardiotomy patients with medically refractory cardiac failure.METHODSWe retrospectively reviewed the records of 73 pediatric patients with congenital heart disease who were placed on ECMO support between August 1984 and February 1994. The patients were divided into groups defined by the timing of ECMO cannulation relative to the time of operation. Group 1 patients (n = 7, 9.6%) were placed on ECMO preoperatively. Group 2 patients (n = 66, 90.4%) were a heterogeneous population placed on ECMO at any interval after cardiac repair. Subgroup 2A consisted of patients (n = 17, 25.8%) who could not be weaned from cardiopulmonary bypass and were converted directly to ECMO support immediately after repair. Subgroup 2B patients (n = 49, 74.2%) were cannulated postoperatively after an initial period of clinical stability.RESULTSHospital survival for all study patients (42/73) and for group 2 patients (38/66) was 58%. Only 4 group 2A patients (23.5%) survived their hospitalization compared with 34 group 2B patients (69.4%) (p = 0.001). Multivariate analysis identified elevated right atrial pressure after ECMO decannulation (p = 0.049) and, possibly, membership in group 2A (p = 0.061) as independent risk factors for hospital death.CONCLUSIONSExtracorporeal membrane oxygenation is most effective in salvaging pediatric cardiac surgical patients who demonstrate medically refractory hemodynamic deterioration at some interval after being successfully weaned from cardiopulmonary bypass. The right atrial pressure after extracorporeal membrane oxygenation decannulation is an independent predictor of hospital death.