Nance Michael L, Nadkarni Vinay M, Hedrick Holly L, Cullen James A, Wiebe Douglas J
Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
J Pediatr Surg. 2009 Aug;44(8):1606-10. doi: 10.1016/j.jpedsurg.2008.10.048.
The aim of the study is to test the effect of age and preextracorporeal membrane oxygenation (pre-ECMO) days of ventilation on ECMO survival in the pediatric population.
Retrospective analysis of noncardiac, pediatric (age >30 days) ECMO patients for the period January 1984 to June 2006. Pre-ECMO demographic, ventilatory, and lung injury severity variables were modeled with stepwise logistic regression to estimate survival probabilities associated with pre-ECMO ventilation duration and patient age. Patients were excluded from review for the following: pre-ECMO cardiac arrest, pre-ECMO ventilation of more than 30 days (chronic), or multiple runs on ECMO.
For the period of review, 2550 patients met inclusion/exclusion criteria. The population had a mean age of 3.6 +/- 5.1 years (median age, 1 year). The mean pre-ECMO days of ventilation were 5.2 +/- 4.9 (median, 4 days). The overall survival probability was 58.6%. The mean oxygen index and Pao(2)/Fio(2) ratio were 62.2 +/- 48.2 and 95.5 +/- 48.2, respectively. The population overall demonstrated a statistically significant, exponential decline in survival as pre-ECMO days of ventilation increased (P < .05). For each additional year of age, survival decreased by an average of 2.5%. For each additional day of pre-ECMO ventilation, survival decreased by an average of 2.9%. Younger ages were generally associated with higher survival probabilities at each ventilation day.
In the pediatric population, survival decreases significantly as pre-ECMO ventilator days increase. Survival is also inversely related to patient age. Thus, patient age and duration of ventilation should be considered when evaluating suitability for ECMO.
本研究旨在测试年龄和体外膜肺氧合（ECMO）前机械通气天数对儿科患者ECMO存活情况的影响。
对1984年1月至2006年6月期间非心脏疾病的儿科（年龄>30天）ECMO患者进行回顾性分析。采用逐步逻辑回归对ECMO前的人口统计学、通气及肺损伤严重程度变量进行建模，以估计与ECMO前机械通气时长及患者年龄相关的存活概率。排除以下患者进行分析：ECMO前发生心脏骤停、ECMO前机械通气超过30天（慢性）或多次接受ECMO治疗。
在研究期间，2550例患者符合纳入/排除标准。研究人群的平均年龄为3.6±5.1岁（中位年龄为1岁）。ECMO前平均机械通气天数为5.2±4.9天（中位数为4天）。总体存活概率为58.6%。平均氧合指数和动脉血氧分压/吸入氧浓度（Pao₂/Fio₂）比值分别为62.2±48.2和95.5±48.2。随着ECMO前机械通气天数增加，研究人群的总体存活情况呈现出具有统计学意义的指数下降（P<.05）。年龄每增加1岁，存活率平均下降2.5%。ECMO前机械通气每增加1天，存活率平均下降2.9%。在每个机械通气日，年龄越小通常存活概率越高。
在儿科患者中，随着ECMO前机械通气天数增加，存活率显著下降。存活率也与患者年龄呈负相关。因此，在评估ECMO适用性时应考虑患者年龄和通气时长。
