Use of extracorporeal life support as a bridge to pediatric cardiac transplantation
Use of extracorporeal life support as a bridge to pediatric cardiac transplantation
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DOI：
10.1016/s1053-2498(02)00476-x
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发表时间：
2003-01-01
影响因子：
8.9
通讯作者：
Kulik, TJ
中科院分区：
文献类型：
--
作者：
Gajarski, RJ;Mosca, RS;Kulik, TJ
背景：体外生命支持（ECLS）已被用于心脏切开术后的抢救，但其作为心脏移植（OHT）的桥梁用于手术后或终末期心力衰竭患者仍存在争议。方法：对接受ECLS治疗的患者进行回顾性分析。从1991年1月到2001年8月的心力衰竭。列出的OHT患者分别进行分析。OHT的要求包括心肌恢复可能性不大，无禁忌症（中枢神经系统损伤、高肺阻力、持续感染等），以及父母同意。结果变量包括患者人口统计学、诊断、从ECLS开始到器官共享联合网络（UNOS）登记的天数（潜伏期）、登记时间、肾功能和生存到出院。结果：145例接受ECLS治疗的心衰患者中，21例儿童患者被列入UNOS名单。124例未登记患者中，57例（46%）存活至出院。除3名幸存者外，其余幸存者均在少于或等于7天内与ECLS分离。12人接受OHT治疗，10人存活至出院（列表时间6天，中位ECLS时间14天）。5例停止ECLS，未接受OHT治疗（1例后接受OHT治疗，2例存活至出院）。5人在接受ECLS时出现并发症，未接受OHT而死亡。9例因肾衰竭需要透析的患者中有6例死亡。所列11例婴儿中，4例从ECLS断奶而未接受OHT（2例存活至出院），5例接受OHT （ECLS支持，4天，4例存活至出院），2例死亡。（ECLS支持，16天和47天）。结论：(1)体外生命支持可以作为OHT（即使在婴儿人群中）至少2周的桥梁，生存率和出院率可接受；(2)肾功能不全伴随透析需求降低了OHT前后的生存可能性。
Background: Extracorporeal life support (ECLS) has been used for post-cardiotomy rescue, but its use as a bridge to heart transplantation (OHT) in patients with postsurgical or end-stage ventricular failure remains controversial.Methods: Records were reviewed for patients receiving ECLS for. ventricular failure from January 1991 to August 2001. Patients listed for OHT were analyzed separately. Listing, for OHT requirements were improbable myocardial recovery, absence of contraindications (central nervous system damage, high pulmonary resistance, ongoing infection, etc.), and parental consent. Outcome variables included patient demographics, diagnosis, days from ECLS initiation to United Network for Organ Sharing (UNOS) listing (latency), list time, renal function, and survival to discharge.Results: Of 145 patients with ventricular failure who received ECLS, 21 pediatric patients were UNOS listed. Of 124 non-listed patients, 57 (46%) survived to discharge. All but 3 survivors were separated from ECLS in less than or equal to7 days. Twelve underwent OHT and 10 survived to discharge (list time, 6 days; median ECLS time, 14 days). Five had ECLS discontinued without, undergoing OHT (1 later underwent OHT, 2 survived to discharge). Five experienced complications while receiving ECLS and died without undergoing OHT. Six of 9 patients who required dialysis for renal failure died. Of 11 infants listed, 4 were weaned from ECLS without undergoing OHT (2 survived to discharge), 5 had OHT (ECLS support, 4 days; 4 survived to discharge) and 2 died. (ECLS support, 16 and 47 days).Conclusions: (1) Extracorporeal life support can be used as a bridge to OHT (even among the infant population) for at least 2 weeks with acceptable survival and hospital discharge rates, and (2) renal insufficiency with the concomitant requirement for dialysis decreases the likelihood of survival before and after OHT.