O'Rourke P P, Lillehei C W, Crone R K, Vacanti J P
Department of Anesthesia (Pediatrics), Children's Hospital and Medical Center, University of Washington, Seattle 98105.
J Pediatr Surg. 1991 Feb;26(2):147-52. doi: 10.1016/0022-3468(91)90896-2.
At The Children's Hospital, Boston (TCH), in the 3 years before extracorporeal membrane oxygenation (ECMO) was available, infants with high-risk congenital diaphragmatic hernia (CDH) had a 47% survival rate. In February 1984, ECMO was introduced and offered to all high-risk CDH infants with a 100% predicted mortality. Since February 1984, 45 infants with high-risk CDH presented to TCH. Twenty-six (58%) were supported with ECMO; 19 (42%) never met the criteria for 100% predicted mortality and were supported with conventional mechanical ventilation (CMV). Overall survival was 49%. Nine (35%) of the 26 ECMO patients survived. Thirteen (68%) of the 19 CMV patients survived. Although there was no change in survival, there was a change in the cause of death. Deaths in the ECMO group were either early (n = 8, secondary to a complication of ECMO or lack of pulmonary improvement) or late (n = 9). The late deaths were infants who were successfully weaned from ECMO, never weaned from CMV, and who died secondary to complications of chronic lung disease.
在波士顿儿童医院（TCH），在体外膜肺氧合（ECMO）可用之前的3年里，患有高危先天性膈疝（CDH）的婴儿存活率为47%。1984年2月，ECMO被引入并提供给所有预测死亡率为100%的高危CDH婴儿。自1984年2月以来，45名高危CDH婴儿被送到TCH。26名（58%）接受了ECMO支持；19名（42%）从未达到预测死亡率为100%的标准，接受了传统机械通气（CMV）支持。总体存活率为49%。26名ECMO患者中有9名（35%）存活。19名CMV患者中有13名（68%）存活。虽然存活率没有变化，但死亡原因发生了变化。ECMO组的死亡要么是早期（n = 8，继发于ECMO并发症或肺部无改善），要么是晚期（n = 9）。晚期死亡的婴儿是那些成功脱离ECMO、从未脱离CMV且死于慢性肺病并发症的婴儿。
