Multicenter Experience With Mechanical Circulatory Support Using a New Diagonal Pump in 233 Children
Multicenter Experience With Mechanical Circulatory Support Using a New Diagonal Pump in 233 Children
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DOI：
10.1111/aor.13016
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发表时间：
2018-04-01
影响因子：
2.4
通讯作者：
Fleck, Thilo
中科院分区：
文献类型：
--
作者：
Stiller, Brigitte;Houmes, Robert Jan;Fleck, Thilo
儿科皮质外生命支持回路的技术创新可以减少系统相关并发症，并可能改善患者的预后。Deltastream DP 3（Medos Medizintechnik AG，Stolberg，德国）是一种新型旋转泵，具有可在宽流量范围内使用的斜流式叶轮。我们从七个儿科中心收集患者数据，进行回顾性队列研究。我们检查了233例患者，中位年龄为1.9（0-201）个月。162例患者使用DP 3系统作为静脉-动脉体外膜肺氧合（ECMO）进行心肺支持。63例患者通过静脉-静脉ECMO提供呼吸支持。该泵在8例患者中用作心室辅助装置。中位支持时间为5.5（0.2 ~ 69）d，脱机率为72.5%。肺部组的出院率为62%，心脏组为55%。24例（10%）行体外循环复苏，存活出院率为37.5%。大约106名（47%）儿童没有出现并发症，而33%的儿童出现出血，需要输血或手术干预。3名患者发生了致命性脑事件。28%的患者进行了肾脏替代治疗，26%的患者进行了泵或氧合器更换。多变量分析确定系统更换（OR 1.94）、肾衰竭（OR 3.43）和支持并发症（OR 2.56）为不良结局的风险因素。这种新型的对角泵已被证明在各种机械循环和呼吸支持中有效，显示出良好的存活率。
Technological innovations in pediatric extra-corporeal life support circuits can reduce system-related complications and may improve patients' outcome. The Deltastream DP3 (Medos Medizintechnik AG, Stolberg, Germany) is a novel rotational pump with a diagonally streamed impeller that can be used over a broad range of flows. We collected patient data from seven pediatric centers to conduct a retrospective cohort study. We examined 233 patients whose median age was 1.9 (0-201) months. The DP3 system was used for cardiopulmonary support as veno-arterial extracorporeal membrane oxygenation (ECMO) in 162 patients. Respiratory support via veno-venous ECMO was provided in 63 patients. The pump was used as a ventricular assist device in eight patients. Median supporting time was 5.5 (0.2-69) days and the weaning rate was 72.5%. The discharge home rate was 62% in the pulmonary group versus 55% in the cardiac group. Extracorporeal cardiopulmonary resuscitation was carried out in 24 patients (10%) with a survival to discharge of rate of 37.5%. About 106 (47%) children experienced no complications, while 33% suffered bleeding requiring blood transfusion or surgical intervention. Three patients suffered a fatal cerebral event. Renal replacement therapy was performed in 28% and pump or oxygenator exchange in 26%. Multivariable analysis identified system exchange (OR 1.94), kidney failure (OR 3.43), and complications on support (OR 2.56) as risk factors for dismal outcome. This novel diagonal pump has demonstrated its efficacy in all kinds of mechanical circulatory and respiratory support, revealing good survival rates.