Should Extracorporeal Membrane Oxygenation Be Offered? An International Survey
Should Extracorporeal Membrane Oxygenation Be Offered? An International Survey
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DOI：
10.1016/j.jpeds.2016.12.025
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发表时间：
2017-03-01
影响因子：
5.1
通讯作者：
Odetola, Folafoluwa O.
中科院分区：
文献类型：
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作者：
Kuo, Kevin W.;Barbaro, Ryan P.;Odetola, Folafoluwa O.
目的了解体外膜肺氧合(ECMO)项目主任对心肺功能衰竭患儿ECMO项目负责人的态度。研究设计在《体外生命支持组织名录》(2015年10月至2015年12月)内对全球ECMO中心ECMO项目主任进行电子横断面调查。结果在733名符合条件的受访者中，226人(31%)完成了调查，其中65%的人经常照顾儿科患者。受访者是否会向5名情景中的任何一名患者提供ECMO的受访者存在很大差异，从31%的受访者会向18三体儿童提供ECMO，到76%的人会向心脏骤停时间延长且神经状态不确定的儿童提供ECMO。即使是从事相同专业的医生有时也会持有非常不同的观点，50%的儿科强化医生表示，他们会为严重发育迟缓的儿童提供ECMO，50%的人表示他们不会。生活质量和神经状况等因素影响决策，并被用来支持支持和反对提供ECMO的决策。结论ECMO项目负责人在是否向不同心肺衰竭儿童提供ECMO方面存在较大差异。医生决策的这种异质性强调了需要更多的证据，这些证据最终可能为ECMO患者选择的机构间指南提供信息。
Objectives To assess the current attitudes of extracorporeal membrane oxygenation (ECMO) program directors regarding eligibility for ECMO among children with cardiopulmonary failure.Study design Electronic cross-sectional survey of ECMO program directors at ECMO centers worldwide within the Extracorporeal Life Support Organization directory (October 2015-December 2015).Results Of 733 eligible respondents, 226 (31%) completed the survey, 65% of whom routinely cared for pediatric patients. There was wide variability in whether respondents would offer ECMO to any of the 5 scenario patients, ranging from 31% who would offer ECMO to a child with trisomy 18 to 76% who would offer ECMO to a child with prolonged cardiac arrest and indeterminate neurologic status. Even physicians practicing the same specialty sometimes held widely divergent opinions, with 50% of pediatric intensivists stating they would offer ECMO to a child with severe developmental delay and 50% stating they would not. Factors such as quality of life and neurologic status influenced decision making and were used to support decisions for and against offering ECMO.Conclusions ECMO program directors vary widely in whether they would offer ECMO to various children with cardiopulmonary failure. This heterogeneity in physician decision making underscores the need for more evidence that could eventually inform interinstitutional guidelines regarding patient selection for ECMO.