Predictors of survival for pediatric extracorporeal cardiopulmonary resuscitation: A systematic review and meta-analysis.
Predictors of survival for pediatric extracorporeal cardiopulmonary resuscitation: A systematic review and meta-analysis.
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DOI：
10.1097/md.0000000000030860
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发表时间：
2022-09-30
期刊：
影响因子：
1.6
通讯作者：
中科院分区：
文献类型：
--
作者：
体外循环心肺复苏术(ECPR)的使用改善了心脏骤停患者的存活率；然而，预测存活率的因素仍然缺乏特征性。一项系统的综述和荟萃分析被用来检验儿科患者ECPR存活的预测因素。我们从2010年到2021年在EMBASE、PubMed、Scope us和Cochrane图书馆中搜索儿科ECPR研究，比较幸存者和非幸存者。分析了30个结果，并将其分为5类：人口学、ECPR前的实验室测量、ECPR前的并存、ECPR内的特征和ECPR后的并发症。共纳入30篇研究(n = 3794)。合并生存率为44%(95%CI：40%~47%，I2 = 为67%)。儿科ECPR存活的重要预测指标包括ECPR前的PaO2、pH、乳酸、PaCO2和肌酐的实验室测量、ECPR前的单心室(SV)合并症、肾功能衰竭、败血症、ECPR特征、体外膜氧合(ECMO)持续时间、ECMO 24小时流量、心肺复苏(CPR)持续时间、可休克节律、ECPR内神经并发症以及ECPR后肺出血、肾功能衰竭和败血症等并发症。在ECPR开始之前，增加的CPR持续时间和乳酸水平与死亡率的相关性最高，其次是pH。ECPR开始后，肺出血和神经系统并发症是最能预测生存的因素。临床医生应该关注这些因素，以便更好地了解患者的潜在预后，建议适当的患者选择，并提高ECPR计划的有效性。
The use of extracorporeal cardiopulmonary resuscitation (ECPR) has improved survival in patients with cardiac arrest; however, factors predicting survival remain poorly characterized. A systematic review and meta-analysis was conducted to examine the predictors of survival of ECPR in pediatric patients. We searched EMBASE, PubMed, SCOPUS, and the Cochrane Library from 2010 to 2021 for pediatric ECPR studies comparing survivors and non-survivors. Thirty outcomes were analyzed and classified into 5 categories: demographics, pre-ECPR laboratory measurements, pre-ECPR co-morbidities, intra-ECPR characteristics, and post-ECPR complications. Thirty studies (n = 3794) were included. Pooled survival to hospital discharge (SHD) was 44% (95% CI: 40%–47%, I2 = 67%). Significant predictors of survival for pediatric ECPR include the pre-ECPR lab measurements of PaO2, pH, lactate, PaCO2, and creatinine, pre-ECPR comorbidities of single ventricle (SV) physiology, renal failure, sepsis, ECPR characteristics of extracorporeal membrane oxygenation (ECMO) duration, ECMO flow rate at 24 hours, cardiopulmonary resuscitation (CPR) duration, shockable rhythm, intra-ECPR neurological complications, and post-ECPR complications of pulmonary hemorrhage, renal failure, and sepsis. Prior to ECPR initiation, increased CPR duration and lactate levels had among the highest associations with mortality, followed by pH. After ECPR initiation, pulmonary hemorrhage and neurological complications were most predictive for survival. Clinicians should focus on these factors to better inform potential prognosis of patients, advise appropriate patient selection, and improve ECPR program effectiveness.