Outcomes after prolonged extracorporeal membrane oxygenation support in children with cardiac disease-Extracorporeal Life Support Organization registry study
Outcomes after prolonged extracorporeal membrane oxygenation support in children with cardiac disease-Extracorporeal Life Support Organization registry study
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DOI：
10.1016/j.jtcvs.2013.09.038
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发表时间：
2014-08-01
影响因子：
6
通讯作者：
Raghuveer, Geetha
中科院分区：
文献类型：
--
作者：
Merrill, Eric Dean;Schoeneberg, Laura;Raghuveer, Geetha
目的：体外膜肺氧合仍是心功能不全患儿机械循环支持启动和维持的主要手段。然而，长期体外膜肺氧合治疗儿童心功能不全的预后仍不明确。方法：我们回顾了国际体外生命支持组织从2000年1月1日到2011年12月31日的数据。我们将长时间的体外膜氧合定义为不间断支持14天。结果：总共有777名出生14天的儿童。其中176人(23%)存活至出院。与死亡者相比，幸存者年龄更大(中位数，0.64岁比0.10岁；P<；.01)，体重更重(中位数体重，7.0公斤；范围2-90；比中位数4.0；范围1.4-100公斤；P<；.01)，支持时间更短(平均20+/-6天比22+/-9天；P<；器官系统并发症(平均2.8+/-1.7vs3.6+/-1.6，P<；.01)。先天性心脏病患儿的存活率低于心肌病和心肌炎患儿(15%比42%和52%；P<0.01)，单室生理性患儿的存活率比二室生理性患儿差(10%比18%，P=0.01)。7%(n=56)的患者接受了心脏移植，其中66%的患者存活到出院，而非移植患者的存活率为19%(P<；.01)。结论：长期的体外膜肺氧合支持治疗儿童心功能不全的损失率较高。心脏移植在这个队列中很少实现，与心脏移植存活的基准相比，死亡率较高。应考虑及早改变护理方向或改用其他机械支持模式作为移植的桥梁。
Objective: Extracorporeal membrane oxygenation remains the mainstay of mechanical circulatory support initiation and maintenance in children with cardiac insufficiency. However, the outcomes after prolonged extracorporeal membrane oxygenation for cardiac insufficiency in children remain ill defined.Methods: We reviewed the International Extracorporeal Life Support Organization data from January 1, 2000, through December 31, 2011. We defined prolonged extracorporeal membrane oxygenation as uninterrupted support for >= 14 days.Results: A total of 777 children aged = 14 days. Of these, 176 (23%) survived to hospital discharge. Compared with the nonsurvivors, the survivors were older (median age, 0.64 vs 0.10 years; P < .01), weighed more (median weight, 7.0 kg; range, 2-90; vs median, 4.0; range, 1.4-100 kg; P < .01), had a shorter duration of support (mean, 20 +/- 6 vs 22 +/- 9 days; P < .01), and a fewer number of organ system complications (mean, 2.8 +/- 1.7 vs 3.6 +/- 1.6, P < .01). Children with congenital heart disease had worse survival than those with cardiomyopathy and myocarditis (15% vs 42% and 52%, respectively; P < .01), and those with 1-ventricle physiology had worse survival than those with 2-ventricle physiology (10% vs 18%, P = .01). Seven percent (n = 56) reached cardiac transplantation, with 66% surviving to hospital discharge versus 19% of those not transplanted (P < .01).Conclusions: The attrition is high after prolonged extracorporeal membrane oxygenation support for cardiac insufficiency in children. Cardiac transplantation in this cohort was rarely achieved and was associated with high mortality compared with benchmarks for cardiac transplantation survival. Earlier redirection of care or conversion to other modes of mechanical support as a bridge to transplantation should be considered.