Veno-Venous Extracorporeal Membrane Oxygenation for Children With Cancer or Hematopoietic Cell Transplant: A Ten Center Cohort.
Veno-Venous Extracorporeal Membrane Oxygenation for Children With Cancer or Hematopoietic Cell Transplant: A Ten Center Cohort.
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DOI：
10.1097/mat.0000000000001336
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发表时间：
2021-08-01
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影响因子：
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通讯作者：
Pediatric ECMO (Pediecmo) Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Extracorporeal Life Support Organization (ELSO)
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作者：
Bridges BC;Kilbaugh TJ;Barbaro RP;Bembea MM;Chima RS;Potera RM;Rosner EA;Sandhu HS;Slaven JE;Tarquinio KM;Cheifetz IM;Rowan CM;Friedman ML;Pediatric ECMO (Pediecmo) Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Extracorporeal Life Support Organization (ELSO)
我们对2011年至2016年在美国接受癌症或造血细胞移植（HCT）并接受静脉-静脉体外膜肺氧合（V-V ECMO）支持的14天至18岁儿童进行了一项多中心回顾性队列研究。我们比较了接受V-V ECMO支持的肿瘤诊断或HCT儿童与接受V-V ECMO支持的其他儿童的结局。在该队列的204例V-V ECMO支持患者中，30例（15%）诊断为癌症或有HCT病史。有21名患者在没有HCT的情况下进行了肿瘤学诊断，9名儿童在HCT后。肿瘤/HCT组的总体ICU死亡率（67% vs. 28%，p<0.001）、ECMO死亡率（43% vs. 21%，p<0.01）和ECMO存活者的ICU死亡率（35% vs. 8%，p<0.01）更高。肿瘤/HCT组转为静脉-动脉（V-A）ECMO的比率更高（23% vs. 9%，p=0.02）（RR 2.5，95% CI 1.1-5.6）。患有癌症或HCT的儿童年龄较大（6.6岁vs 2.9岁，p=0.02），肌酐水平较高（0.65 mg/dL vs 0.4 mg/dL，p=0.04），但其他ECMO前变量与其他队列相似。对于HCT后患者，与其他非恶性适应症（3/3）相比，HCT适应症为癌症或免疫缺陷（0/6）的患者的生存率显著更差（p=0.01）。
We performed a multi-center retrospective cohort study of children aged 14 days to 18 years in the United States from 2011 to 2016 with cancer or hematopoietic cell transplant (HCT) who were supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO). We compared the outcomes of children with oncological diagnoses or HCT supported with V-V ECMO to other children who have received V-V ECMO support. In this cohort of 204 patients supported with V-V ECMO, 30 (15%) had a diagnosis of cancer or a history of HCT. There were 21 patients who had oncological diagnoses without HCT and 9 children were post-HCT. The oncology/HCT group had a higher overall ICU mortality (67% vs. 28%, p<0.001), mortality on ECMO (43% vs 21%, p<0.01), and ICU mortality among ECMO survivors (35% vs 8%, p<0.01). The oncology/HCT group had a higher rate of conversion to veno-arterial (V-A) ECMO (23% vs. 9%, p=0.02) (RR 2.5, 95% CI 1.1–5.6). Children with cancer or HCT were older (6.6 years vs 2.9 years, p=0.02) and had higher creatinine levels (0.65 mg/dL vs 0.4 mg/dL, p=0.04) but were similar to the rest of the cohort for other pre-ECMO variables. For post-HCT patients, survival was significantly worse for those whose indication for HCT was cancer or immunodeficiency (0/6) as compared to other nonmalignant indications (3/3) (p=0.01).