Hintz Susan R, Benitz William E, Colby Christopher E, Sheehan Arlene M, Rycus Peter, Van Meurs Krisa P
Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA.
Pediatr Crit Care Med. 2005 Jan;6(1):33-8. doi: 10.1097/01.PCC.0000149135.95884.65.
Extracorporeal life support for neonatal respiratory failure has decreased, but utilization and outcome of cardiac extracorporeal life support are not well characterized. Among neonates born 1996-2000, our objects were to evaluate changes in utilization and outcome of cardiac extracorporeal life support and characterize correlates of survival.
Retrospective analysis of Extracorporeal Life Support Organization Registry data.
Intensive care units participating in the ELSO registry.
Patients placed on extracorporeal life support for center-specified "cardiac support" at </=30 days of age from 1996 to 2000. Patients with hypoplastic left heart syndrome were also analyzed separately.
None.
Patient characteristics and correlates of survival to discharge or transfer were analyzed by chi-square, Student's t-test, and logistic regression analysis. Neonates placed on cardiac extracorporeal life support increased from 112 in 1996 to 200 in 2000 (total n = 740). Overall survival was 34.2%: 28% for hypoplastic left heart syndrome and 35.4% for nonhypoplastic left heart syndrome. For the overall group, no significant correlations were found between survival and year on extracorporeal life support, multiple runs, or diagnosis of hypoplastic left heart syndrome. Diagnoses of transposition of the great arteries (p = .03) or persistent pulmonary hypertension of the neonate (p = .004) and extracorporeal life support at <3 days (p = .003) were associated with higher survival. Survivors had fewer mean extracorporeal life support hours (125.5 +/- 121.4 vs. 159.0 +/- 127.6, p = .0006). Logistic regression confirmed significant bivariate findings. A total of 118 hypoplastic left heart syndrome patients were reported from 1996 to 2000. Extracorporeal life support at >15 days was associated with improved survival among hypoplastic left heart syndrome patients (p = .03), and survivors had fewer mean extracorporeal life support hours (89.3 +/- 52.3 vs. 147.5 +/- 129.7, p = .015). Logistic regression showed that only greater number of hours on extracorporeal life support was independently associated with nonsurvival.
Neonatal cardiac extracorporeal life support use increased substantially from 1996 to 2000, with survival to discharge or transfer in more than one third of patients. Hypoplastic left heart syndrome was not associated with nonsurvival. Fewer hours on extracorporeal life support, diagnoses of persistent pulmonary hypertension of the neonate and transposition of the great arteries, and extracorporeal life support at <3 days were associated with survival.
新生儿呼吸衰竭体外生命支持的应用有所减少，但心脏体外生命支持的使用情况及结局尚未得到充分描述。在1996 - 2000年出生的新生儿中，我们旨在评估心脏体外生命支持的使用变化及结局，并确定生存的相关因素。
对体外生命支持组织注册数据进行回顾性分析。
参与体外生命支持组织注册的重症监护病房。
1996年至2000年出生后≤30天因中心指定的“心脏支持”接受体外生命支持的患者。左心发育不全综合征患者也单独进行分析。
无。
通过卡方检验、学生t检验和逻辑回归分析患者特征及出院或转院生存的相关因素。接受心脏体外生命支持的新生儿从1996年的112例增加到2000年的200例（总数n = 740）。总体生存率为34.2%：左心发育不全综合征患者为28%，非左心发育不全综合征患者为35.4%。对于总体组，未发现生存率与体外生命支持时间、多次运行或左心发育不全综合征诊断之间存在显著相关性。大动脉转位（p = 0.03）或新生儿持续性肺动脉高压（p = 0.004）的诊断以及出生<3天接受体外生命支持（p = 0.003）与较高的生存率相关。幸存者的平均体外生命支持时间较少（125.5±121.4 vs. 159.0±127.6，p = 0.0006）。逻辑回归证实了显著的双变量结果。1996年至2000年共报告118例左心发育不全综合征患者。出生>15天接受体外生命支持与左心发育不全综合征患者生存率提高相关（p = 0.03），且幸存者的平均体外生命支持时间较少（89.3±52.3 vs. 147.5±129.7，p = 0.015）。逻辑回归显示，仅体外生命支持时间越长与非生存独立相关。
1996年至2000年，新生儿心脏体外生命支持的使用显著增加，超过三分之一的患者存活至出院或转院。左心发育不全综合征与非生存无关。体外生命支持时间较短、新生儿持续性肺动脉高压和大动脉转位的诊断以及出生<3天接受体外生命支持与生存相关。
