Morris Marilyn C, Ittenbach Richard F, Godinez Rodolfo I, Portnoy Joel D, Tabbutt Sarah, Hanna Brian D, Hoffman Timothy M, Gaynor J William, Connelly James T, Helfaer Mark A, Spray Thomas L, Wernovsky Gil
Children's Hospital of Philadelphia, Department of Anesthesia and Critical Care Medicine, USA.
Crit Care Med. 2004 Apr;32(4):1061-9. doi: 10.1097/01.ccm.0000119425.04364.cf.
To identify factors associated with mortality in children with heart disease managed with extracorporeal membrane oxygenation (ECMO).
Retrospective chart review.
Tertiary care university-affiliated children's hospital.
All pediatric cardiac intensive care unit patients managed with ECMO between January 1, 1995, and June 30, 2001.
None.
During the study period, 137 patients were managed with ECMO in the pediatric cardiac intensive care unit. Of the 137 patients, 80 (58%) survived > or =24 hrs after decannulation, and 53 (39%) survived to hospital discharge. Patients managed with ECMO following cardiac surgery were analyzed separately from patients not in the postoperative period. Factors associated with an increased probability of mortality in the postoperative patients were age <1 month, male gender, longer duration of mechanical ventilation before ECMO, and development of renal or hepatic dysfunction while on ECMO. Single ventricle physiology and failure to separate from cardiopulmonary bypass were not associated with an increased risk of mortality. Cardiac physiology and indication for ECMO were not associated with mortality rate. Although longer duration of ECMO was not associated with increased mortality risk, patients with longer duration of ECMO were less likely to survive without heart transplantation.
In a series of 137 patients managed with ECMO in a pediatric cardiac intensive care unit, survival to hospital discharge was 39%. In postoperative patients only, mortality risk was increased in males, patients <1 month old, patients with a longer duration of mechanical ventilation before initiation of ECMO, and patients who developed renal or hepatic failure while on ECMO.
确定接受体外膜肺氧合（ECMO）治疗的心脏病患儿的死亡相关因素。
回顾性病历审查。
大学附属三级医疗儿童医院。
1995年1月1日至2001年6月30日期间在儿科心脏重症监护病房接受ECMO治疗的所有儿科患者。
无。
在研究期间，137例患者在儿科心脏重症监护病房接受了ECMO治疗。137例患者中，80例（58%）在拔管后存活≥24小时，53例（39%）存活至出院。接受心脏手术后使用ECMO治疗的患者与非术后患者分开分析。术后患者死亡概率增加的相关因素包括年龄<1个月、男性、ECMO前机械通气时间较长以及在ECMO治疗期间出现肾或肝功能障碍。单心室生理状态和体外循环后未能脱离与死亡风险增加无关。心脏生理状态和ECMO的指征与死亡率无关。虽然ECMO持续时间较长与死亡风险增加无关，但ECMO持续时间较长的患者在不进行心脏移植的情况下存活的可能性较小。
在一家儿科心脏重症监护病房接受ECMO治疗的137例患者中，出院存活率为39%。仅在术后患者中，男性、年龄<1个月的患者、ECMO开始前机械通气时间较长的患者以及在ECMO治疗期间出现肾衰竭或肝衰竭的患者死亡风险增加。
