Booth Karen L, Roth Stephen J, Thiagarajan Ravi R, Almodovar Melvin C, del Nido Pedro J, Laussen Peter C
Department of Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
Ann Thorac Surg. 2004 Apr;77(4):1341-8. doi: 10.1016/j.athoracsur.2003.09.042.
Extracorporeal membrane oxygenation can provide effective mechanical circulatory support for the failing circulation in children. Patients with failing Fontan and bidirectional Glenn physiology present additional challenges both for extracorporeal membrane oxygenation cannulation and support. We report our institutional experience in patients with cavopulmonary connections who received extracorporeal membrane oxygenation.
We performed a retrospective review of 20 patients with cavopulmonary connections (14 Fontan and 6 bidirectional Glenn) who were supported with extracorporeal membrane oxygenation from a single, large pediatric tertiary care center.
Of the 20 patients, ten were supported and decannulated successfully (50%) (two after cardiac transplantation), but only six (30%) are alive at follow-up. Of the 14 Fontan patients, seven (50%) were withdrawn from extracorporeal membrane oxygenation or died within 48 hours of decannulation due to lack of myocardial recovery or severe neurologic injury. All four adult-sized (> 40 kg) Fontan patients were withdrawn from extracorporeal support. The seven Fontan patients who were successfully decannulated survived to discharge, and five (35.7%) are alive at follow-up (median 35 months; range, 7 to 140 months). Of the six bidirectional Glenn patients, five died before hospital discharge and the lone survivor has neurologic injury at follow-up.
Patients with failing Fontan and bidirectional Glenn physiology present significant challenges to successful extracorporeal membrane oxygenation support. While the morbidity and mortality rates are high, there are select patients for whom extracorporeal support can be effective and lifesaving as a short-term resuscitative intervention.
体外膜肺氧合可为儿童衰竭的循环系统提供有效的机械循环支持。对于采用Fontan手术和双向格林手术且生理功能衰竭的患者，体外膜肺氧合插管和支持面临更多挑战。我们报告在接受体外膜肺氧合的腔肺连接患者中的机构经验。
我们对来自一家大型儿科三级医疗中心的20例接受体外膜肺氧合支持的腔肺连接患者（14例Fontan手术患者和6例双向格林手术患者）进行了回顾性研究。
20例患者中，10例成功获得支持并拔除插管（50%）（2例在心脏移植后），但随访时仅6例（30%）存活。14例Fontan手术患者中，7例（50%）因心肌恢复不佳或严重神经损伤在拔除插管后48小时内撤离体外膜肺氧合或死亡。所有4例体重超过40 kg的Fontan手术成年患者均撤离体外支持。7例成功拔除插管的Fontan手术患者存活至出院，5例（35.7%）在随访时存活（中位时间35个月；范围7至140个月）。6例双向格林手术患者中，5例在出院前死亡，唯一的幸存者在随访时有神经损伤。
采用Fontan手术和双向格林手术且生理功能衰竭的患者在成功接受体外膜肺氧合支持方面面临重大挑战。虽然发病率和死亡率很高，但对于某些患者，体外支持作为短期复苏干预措施可能有效且能挽救生命。
