Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.
Pediatr Crit Care Med. 2011 Mar;12(2):133-6. doi: 10.1097/PCC.0b013e3181e2a4a1.
To demonstrate positive outcome, to achieve higher flow rates, and to reverse shock more quickly by implementing central extracorporeal membrane oxygenation (ECMO) in children with refractory septic shock. Children hospitalized with sepsis have significant mortality rates. The development of shock is the most important risk factor for death. For children with septic shock refractory to all other forms of therapy, ECMO has been recommended but estimated survival is <50% and the best method of applying the technology is unknown. In recent years, our institutional practice has been to cannulate children with refractory septic shock directly through the chest (central, atrioaortic ECMO) to achieve higher blood flow rates.
Retrospective case series.
Intensive care unit of a tertiary referral pediatric hospital.
Twenty-three children with refractory septic shock who received central ECMO primarily as circulatory support.
Central ECMO.
The primary outcome measure was survival to hospital discharge. Pre-ECMO circulatory and ventilatory parameters, infecting organism, duration and complications of ECMO and length of hospital stay were also collected. Twenty-three patients (median: age, 6 yrs; weight, 20 kg) over a 9-yr period were included. All patients had microbiological evidence of infection, and meningococcemia was the most common diagnosis. Twenty-two (96%) patients had failure of at least three organ systems, and all patients received at least two inotropes with a mean inotrope score of 82.2 (sd, 115.6). Eight (35%) patients suffered cardiac arrest and required external cardiac massage before ECMO. Eighteen (78%) patients survived to be decannulated off ECMO, and 17 (74%) children survived to hospital discharge. Higher pre-ECMO arterial lactate levels were associated with increased mortality (11.7 mmol/L in nonsurvivors vs. 6.0 mmol/L in survivors, p = .007).
Central ECMO seems to be associated with better survival than conventional ECMO and should be considered by clinicians as a viable strategy in children with refractory septic shock.
通过在难治性感染性休克患儿中实施中心体外膜肺氧合（ECMO），以展示良好的治疗效果，实现更高的血流速度，并更快地逆转休克。患有败血症的住院儿童死亡率很高。休克的发生是死亡的最重要危险因素。对于所有其他治疗方法均无效的感染性休克患儿，已推荐使用 ECMO，但估计存活率<50%，且应用该技术的最佳方法尚不清楚。近年来，我们的机构治疗实践是通过胸部直接给难治性感染性休克患儿置管（中心，主动脉-冠状动脉 ECMO）以实现更高的血流速度。
回顾性病例系列。
一家三级转诊儿科医院的重症监护病房。
23 例主要接受循环支持的难治性感染性休克患儿。
中心 ECMO。
主要结局指标是住院期间的存活率。还收集了 ECMO 前的循环和通气参数、感染病原体、ECMO 持续时间和并发症以及住院时间等。在 9 年期间，共纳入 23 例患者（中位数年龄：6 岁；体重：20 千克）。所有患者均有感染的微生物学证据，脑膜炎球菌血症是最常见的诊断。22 例（96%）患者至少有 3 个器官系统衰竭，所有患者均至少接受了 2 种正性肌力药物治疗，平均正性肌力药物评分 82.2（标准差，115.6）。8 例（35%）患者发生心脏骤停，在 ECMO 前需要体外心脏按摩。18 例（78%）患者成功脱机，17 例（74%）患儿存活出院。ECMO 前较高的动脉乳酸水平与死亡率增加相关（死亡组 11.7mmol/L，存活组 6.0mmol/L，p =.007）。
中心 ECMO 似乎比传统 ECMO 具有更好的生存率，临床医生应将其视为难治性感染性休克患儿的可行治疗策略。
