Ventricular Performance is Associated with Need for Extracorporeal Membrane Oxygenation in Newborns with Congenital Diaphragmatic Hernia
Ventricular Performance is Associated with Need for Extracorporeal Membrane Oxygenation in Newborns with Congenital Diaphragmatic Hernia
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DOI：
10.1016/j.jpeds.2017.08.060
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发表时间：
2017-12-01
影响因子：
5.1
通讯作者：
Tacy, Theresa A.
中科院分区：
文献类型：
--
作者：
Altit, Gabriel;Bhombal, Shazia;Tacy, Theresa A.
目的比较需要体外膜肺氧合（ECMO）和非ECMO治疗的先天性腹股沟疝（CDH）患者的超声心动图（ECHO）结果。研究设计我们回顾了2009年至2016年出生的CDH新生儿的临床和ECHO数据。排除包括重大异常、遗传综合征或ECMO前无ECHO。通过导管分流和三尖瓣返流来评估肺动脉高压。结果CDH患者（15例ECMO和29例非ECMO）进行了分析。大多数患者为左侧CDH（88.6%）。两组间ECHO时的年龄相似。出生状态（P = 0.009）和肝脏位置（P = 0.009）与ECMO的需要相关。与非ECMO患者相比，需要ECMO的患者通过常规和STE测量的左心室和右心室功能均显著降低，并且右心室和左心室输出量均降低。ECMO患者的右心室偏心率指数高于非ECMO患者（2.2 vs 1.8，P = 0.02）。CDH组之间的肺动脉高压无差异。结论ECMO的需要与左、右心室功能下降有关，通过标准和STE测量评估。非ECMO组与ECMO组肺动脉高压无差异。心功能异常可以解释CDH患者对肺血管扩张剂无反应。改善心脏功能的管理策略可能会减少新生儿CDH对ECMO的需求。
Objective To compare echocardiography (ECHO) findings of patients with congenital diaphragmatic hernia (CDH) who required extracorporeal membrane oxygenation (ECMO) to non-ECMO treated patients.Study design We reviewed clinical and ECHO data of newborns with CDH born between 2009 and 2016. Exclusions included major anomalies, genetic syndromes, or no ECHO prior to ECMO. Pulmonary hypertension was assessed by ductal shunting and tricuspid regurgitant jet. Speckle tracking echocardiography (STE) assessed function by quantifying deformation.Results Patients with CDH (15 ECMO and 29 with no ECMO) were analyzed. Most patients had a left CDH (88.6%). Age at ECHO was similar between groups. Outborn status (P = .009) and liver position (P = .009) were associated with need for ECMO. Compared with non-ECMO patients, patients who required ECMO had significantly decreased left and right ventricular function by both conventional and STE measures, as well as decreased right and left ventricular output. The right ventricular eccentricity index was higher in ECMO vs non-ECMO patients (2.2 vs 1.8, P = .02). There was no difference in pulmonary hypertension between CDH groups.Conclusions Need for ECMO was associated with decreased left and right ventricular function, as assessed by standard and STE measures. There was no difference in pulmonary hypertension between non ECMO and ECMO patients. Abnormal cardiac function may explain nonresponse to pulmonary vasodilators in patients with CDH. Management strategies to improve cardiac function may reduce the need for ECMO in newborns with CDH.