Pediatr Crit Care Med. 2010 May;11(3):362-71. doi: 10.1097/PCC.0b013e3181c0141b.
Describe the use of extracorporeal cardiopulmonary resuscitation as rescue therapy in pediatric patients who experience cardiopulmonary arrest refractory to conventional resuscitation. We report on outcomes and factors associated with survival in children treated with extracorporeal cardiopulmonary resuscitation during cardiopulmonary arrest from the American Heart Association National Registry of CardioPulmonary Resuscitation.
Multicentered, national registry of in-hospital cardiopulmonary resuscitation.
Two hundred eighty-five hospitals reporting to the registry from January 2000 to December 2007.
Pediatric patients <18 yrs of age who received extracorporeal membrane oxygenation during cardiopulmonary resuscitation for in-hospital cardiopulmonary arrest.
None.
Prearrest and arrest variables were collected. The primary outcome variable was survival to hospital discharge. The secondary outcome was neurologic status after extracorporeal cardiopulmonary resuscitation at hospital discharge. Favorable neurologic outcome was defined as Pediatric Cerebral Performance Categories 1, 2, 3, or no change from admission Pediatric Cerebral Performance Category.
Of 6288 pediatric cardiopulmonary arrest events reported, 199 (3.2%) index extracorporeal cardiopulmonary resuscitation events were identified; 87 (43.7%) survived to hospital discharge. Fifty-nine survivors had Pediatric Cerebral Performance Category outcomes recorded, and of those, 56 (94.9%) had favorable outcomes. In a multivariable model, the prearrest factor of renal insufficiency and arrest factors of metabolic or electrolyte abnormality and the pharmacologic intervention of sodium bicarbonate/tromethamine were associated with decreased survival. After adjusting for confounding factors, cardiac illness category was associated with an increased survival to hospital discharge.
Forty-four percent of pediatric patients who failed conventional cardiopulmonary resuscitation from in-hospital cardiopulmonary arrest and who were reported to the National Registry of CardioPulmonary Resuscitation database as treated with extracorporeal cardiopulmonary resuscitation survived to hospital discharge. The majority of survivors with recorded neurologic outcomes were favorable. Patients with cardiac illness category were more likely to survive to hospital discharge after treatment with extracorporeal cardiopulmonary resuscitation. Extracorporeal cardiopulmonary resuscitation should be considered for select pediatric patients refractory to conventional in-hospital resuscitation measures.
描述体外心肺复苏（extracorporeal cardiopulmonary resuscitation，ECPR）在常规复苏无效的心肺骤停儿科患者中的抢救治疗作用。我们报告了美国心脏协会心肺复苏国家注册中心（American Heart Association National Registry of CardioPulmonary Resuscitation）登记的心肺骤停期间接受 ECPR 治疗的儿童的结局和与生存相关的因素。
多中心、全国性院内心肺复苏登记。
2000 年 1 月至 2007 年 12 月向登记处报告的 285 家医院。
接受 ECPR 治疗的 18 岁以下院内心肺骤停患儿。
无。
收集了复苏前和复苏时的变量。主要结局变量为出院时的生存。次要结局为出院时 ECPR 后的神经功能状态。良好的神经功能预后定义为小儿脑功能分类（Pediatric Cerebral Performance Categories，PCPC）1、2、3 级或与入院时 PCPC 相比无变化。
在报告的 6288 例儿科心肺骤停事件中，确定了 199 例（3.2%）索引 ECPR 事件；87 例（43.7%）出院时存活。59 例存活者记录了小儿脑功能分类结局，其中 56 例（94.9%）预后良好。在多变量模型中，肾损伤的复苏前因素、代谢或电解质异常的复苏因素以及碳酸氢钠/三羟甲基氨基甲烷的药物干预与生存率降低有关。在调整混杂因素后，心脏疾病类别与出院时的生存率增加有关。
在报告给心肺复苏国家登记数据库的因院内心肺骤停而接受 ECPR 治疗的常规心肺复苏失败的儿科患者中，44%存活至出院。记录神经功能结局的大多数存活者预后良好。接受 ECPR 治疗后，心脏疾病类别的患者更有可能存活至出院。对于常规院内复苏措施无效的选择儿科患者，应考虑 ECPR。
