Decreased Brain Volumes and Infants With Congenital Heart Disease Undergoing Venoarterial Extracorporeal Membrane Oxygenation
Decreased Brain Volumes and Infants With Congenital Heart Disease Undergoing Venoarterial Extracorporeal Membrane Oxygenation
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DOI：
10.1097/pcc.0000000000002336
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发表时间：
2020-08-01
影响因子：
4.1
通讯作者：
Miller, Steven P.
中科院分区：
文献类型：
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作者：
Chao, Brandon K.;Claessens, Nathalie H. P.;Miller, Steven P.
目的：本研究的目的是：i）确定脑损伤的范围，ii）比较接受体外膜氧合的婴儿与不需要体外膜氧合的婴儿的术前和术后脑部MRI的脑容量。设计：对患有大动脉转位或单心室生理学的婴儿进行队列研究。使用体积T1加权梯度回波序列分割测量脑体积（cm（3））。分析脑成像结果（脑室内出血、白色损伤和卒中）与脑损伤和不良神经发育结局的已知临床风险因素。通过回顾性病历审查收集临床因素。脑容量和体外膜肺氧合之间的关联使用广义估计方程进行评估，以解释重复测量。设置：前瞻性和单中心研究。患者：根据临床方案，对109名患有大动脉转位（n= 77）或单心室生理学（n= 32）的婴儿（中位胎龄，39.1周）进行了术前和术后MRI研究。干预措施：无。测量和主要结果：在接受体外膜肺氧合的28例婴儿（26%）中，19例（68%）接受了1次体外膜肺氧合支持，9例（32%）接受了2-4次支持。在术后MRI上，仅在5例（17%）体外膜氧合婴儿中发现了新的白色损伤，而在非体外膜氧合组中为40例（49%）（p= 0.073）。非体外膜肺氧合组和体外膜肺氧合组的卒中（9%对10%）、脑室内出血（24%对29%）和缺氧缺血（3%对14%）发生率没有差异（均P> 0.5）。考虑到大动脉转位或单心室生理学诊断，需要体外膜氧合的婴儿在单次（β = -1.67）或多次体外膜氧合运行（[β = -6.54];总体相互作用p = 0.012）时脑容量较慢。结论：在我们中心接受体外膜肺氧合治疗的大动脉d型转位或单心室患者与不需要体外膜肺氧合的患者相比，脑损伤的发生率相似，但围手术期脑容量受损更显著。
Objectives: The aims of this study were to: i) determine the spectrum of brain injury and ii) compare brain volumes between pre- and postoperative brain MRI in the infants receiving extracorporeal membrane oxygenation compared with those who did not require extracorporeal membrane oxygenation. Design: Cohort study of infants withd-transposition of the great arteries or single ventricle physiology. Brain volume (cm(3)) was measured using a segmentation of a volumetric T1-weighted gradient echo sequence. Brain imaging findings (intraventricular hemorrhage, white matter injuries, and stroke) were analyzed with respect to known clinical risk factors for brain injury and adverse neurodevelopmental outcomes. Clinical factors were collected by retrospective chart review. The association between brain volume and extracorporeal membrane oxygenation was evaluated using generalized estimating equations to account for repeated measures. Setting: Prospective and single-centered study. Patients: One hundred nine infants (median gestational age, 39.1 wk) withd-transposition of the great arteries (n= 77) or single ventricle physiology (n= 32) were studied pre- and postoperatively with MRI as per clinical protocol. Interventions: None. Measurements and Main Results: Of the 28 infants (26%) receiving extracorporeal membrane oxygenation, 19 (68%) were supported with extracorporeal membrane oxygenation once, and nine (32%) were supported 2-4 times. On postoperative MRI, new white matter injury was found in only five (17%) of the extracorporeal membrane oxygenation infants versus 40 (49%) in the non-extracorporeal membrane oxygenation group (p= 0.073). The rate of stroke (9% vs 10%), intraventricular hemorrhage (24% vs 29%), and hypoxic ischemia (3% vs 14%) did not differ between the non-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation groups (allp> 0.5). Accounting ford-transposition of the great arteries or single ventricle physiology diagnosis, infants requiring extracorporeal membrane oxygenation had slower brain volume with single (beta = -1.67) or multiple extracorporeal membrane oxygenation runs ([beta = -6.54]; overall interactionp= 0.012). Conclusions: Patients with d-transposition of the great arteries or single ventricle physiology undergoing extracorporeal membrane oxygenation at our center have a similar incidence of brain injury but more significant impairment of perioperative brain volumes than those not requiring extracorporeal membrane oxygenation.