Morris Marilyn C, Wernovsky Gil, Nadkarni Vinay M
Clinical Pediatrics, The Children's Hospital of New York, New York, NY, USA.
Pediatr Crit Care Med. 2004 Sep;5(5):440-6. doi: 10.1097/01.pcc.0000137356.58150.2e.
To report survival outcomes and to identify factors associated with survival following extracorporeal cardiopulmonary resuscitation for in-hospital pediatric cardiac arrest.
Retrospective chart review, consecutive case series.
Survival to hospital discharge.
During a 7-yr study period, there were 66 cardiac arrest events in 64 patients in which a child was cannulated for extracorporeal membrane oxygenation during active cardiopulmonary resuscitation with chest compressions. A total of 33 of 66 events (50%) resulted in the child being decannulated and surviving at least 24 hrs; 21 of 64 (33%) children undergoing extracorporeal cardiopulmonary resuscitation survived to hospital discharge. A total of 19 of 43 children with isolated heart disease compared with two of 21 children with other medical conditions survived to hospital discharge (p <.01). Pediatric Cerebral Performance Category and Pediatric Overall Performance Category were determined for survivors >2 months old. Five of ten extracorporeal cardiopulmonary resuscitation survivors >2 months old had no change in Pediatric Cerebral Performance Category or Pediatric Overall Performance Category compared with admission. Three of six extracorporeal cardiopulmonary resuscitation patients who survived after receiving >60 mins of chest compressions before extracorporeal cardiopulmonary resuscitation had grossly intact neurologic function. During a 2-yr period in the same hospital, no patient who received >30 mins of cardiopulmonary resuscitation without extracorporeal cardiopulmonary resuscitation survived. In this case series, age, weight, or duration of chest compressions before extracorporeal cardiopulmonary resuscitation did not correlate with survival.
Extracorporeal cardiopulmonary resuscitation can be used to successfully resuscitate selected children following refractory in-hospital cardiac arrest, and can be implemented during active cardiopulmonary resuscitation. Intact neurologic survival can sometimes be achieved, even when the duration of in-hospital cardiopulmonary resuscitation is prolonged. In this series, children with isolated heart disease were more likely to survive following extracorporeal cardiopulmonary resuscitation than were children with other medical conditions.
报告院内心脏骤停小儿体外心肺复苏后的生存结局，并确定与生存相关的因素。
回顾性病历审查，连续病例系列。
存活至出院。
在为期7年的研究期间，64例患者发生了66次心脏骤停事件，其中在进行胸外按压的同时积极进行心肺复苏期间，有儿童接受了体外膜肺氧合插管。66次事件中有33次（50%）导致患儿拔管并存活至少24小时；64例接受体外心肺复苏的患儿中有21例（33%）存活至出院。43例患有孤立性心脏病的患儿中有19例存活至出院，而21例患有其他疾病的患儿中有2例存活至出院（p<0.01）。对年龄大于2个月的幸存者确定了小儿脑功能分类和小儿总体功能分类。10例年龄大于2个月的体外心肺复苏幸存者中有5例与入院时相比，小儿脑功能分类或小儿总体功能分类无变化。6例在接受体外心肺复苏前胸外按压时间超过60分钟后存活的体外心肺复苏患者中有3例神经功能基本完好。在同一家医院的2年期间，没有接受超过30分钟非体外心肺复苏的心肺复苏的患者存活。在这个病例系列中，年龄、体重或体外心肺复苏前胸外按压的持续时间与生存无关。
体外心肺复苏可用于成功复苏难治性院内心脏骤停后的部分儿童，并且可在积极进行心肺复苏期间实施。即使院内心肺复苏时间延长，有时也能实现神经功能完好的存活。在这个系列中，患有孤立性心脏病的儿童在体外心肺复苏后比患有其他疾病的儿童更有可能存活。
