Kelly Robert B, Harrison Rick E
Department of Pediatrics, Division of Critical Care, David Geffen School of Medicine at UCLA, Mattel Children's Hospital UCLA,Los Angeles, CA, 90095, USA.
Pediatr Cardiol. 2010 Jul;31(5):626-33. doi: 10.1007/s00246-010-9659-z. Epub 2010 Feb 10.
Extracorporeal cardiopulmonary resuscitation (ECPR) allows clinicians to potentially rescue pediatric patients unresponsive to traditional cardiopulmonary resuscitation (CPR). Clinical and laboratory variables predictive of survival to hospital discharge are beginning to emerge. In this retrospective, historical cohort case series, clinical, and laboratory data from 31 pediatric patients (<21 years of age) receiving ECPR from March 2000 to April 2006 at our university-affiliated, tertiary-care children's hospital were statistically analyzed in an attempt to identify variables predictive of survival to hospital discharge. Seven patients survived to hospital discharge (23%), and 24 patients died. Survival was independent of gender, age, and CPR duration. ECPR survival was, however, associated with a lower pre-ECPR phosphorus concentration (P = 0.002) and a lower pre-ECPR creatinine concentration (P = 0.05). A classification tree analysis, using, in part, a pre-ECPR phosphorus concentration threshold and a CPR ABG base excess concentration threshold, yielded a 96% nominal accuracy of predicting survival to hospital discharge or death. A large, multicenter, prospective cohort study aimed at validating these predictive variables is needed to guide appropriate ECPR patient selection. This study reveals the potential survival benefit of ECPR for pediatric patients, regardless of CPR duration prior to ECPR cannulation.
体外心肺复苏（ECPR）使临床医生有可能挽救对传统心肺复苏（CPR）无反应的儿科患者。预测出院存活的临床和实验室变量已开始显现。在这项回顾性、历史性队列病例系列研究中，对2000年3月至2006年4月在我们大学附属的三级儿童专科医院接受ECPR的31例年龄小于21岁的儿科患者的临床和实验室数据进行了统计分析，以试图确定预测出院存活的变量。7例患者存活至出院（23%），24例患者死亡。存活与性别、年龄和CPR持续时间无关。然而，ECPR存活与ECPR前较低的磷浓度（P = 0.002）和较低的ECPR前肌酐浓度（P = 0.05）相关。一项分类树分析，部分使用ECPR前磷浓度阈值和CPR动脉血气碱剩余浓度阈值，预测出院存活或死亡的标称准确率为96%。需要进行一项大型、多中心、前瞻性队列研究来验证这些预测变量，以指导合适的ECPR患者选择。本研究揭示了ECPR对儿科患者的潜在生存益处，无论在ECPR插管前的CPR持续时间如何。
