Division of Cardiothoracic Surgery, Washington University in St Louis, St Louis, MO, USA.
J Thorac Cardiovasc Surg. 2010 Aug;140(2):427-32. doi: 10.1016/j.jtcvs.2010.04.012. Epub 2010 Jun 9.
Effectiveness of preoperative and postoperative extracorporeal membrane oxygenation support in pediatric lung transplantation was studied.
Institutional database of pediatric lung transplants from 1990 to 2008 was reviewed.
Three hundred forty-four patients underwent lung transplants in the study period. Thirty-three of 344 patients (9.6%) required perioperative extracorporeal membrane oxygenation support. Fifteen patients (median, age 1.3 years; range, 0.2-18 years) required 16 pretransplant extracorporeal membrane oxygenation runs. Indications were respiratory failure (8/16, 50%), severe pulmonary hypertension (5/16, 31%), and cardiopulmonary collapse (3/16, 19%). Four of these patients (27%) also required postoperative support. Six (40%) were weaned before lung transplant. Six (40%) survived to hospital discharge. Survival to discharge was higher among patients weaned before lung transplant (4/6, 66% vs 2/9, 22%). Twenty-two patients (median age, 9.4 years; range, 0.2-21 years) underwent 24 extracorporeal membrane oxygenation runs after lung transplant. Indications for postoperative support were primary graft dysfunction (18/24, 75%), pneumonia (4/24, 16%), and others (2/24, 9%). Median time between lung transplant and institution of extracorporeal membrane oxygenation was 32 hours (range, 0-1084 hours); median duration of support was 141 hours (range, 48-505 hours). Five of these patients (23%) survived to hospital discharge. Among nonsurvivors, causes of death were intractable respiratory failure (12/17, 70%) and infectious complications (4/17, 24%).
Need for perioperative extracorporeal membrane oxygenation support is associated with significant morbidity and mortality among pediatric patients receiving lung transplants. A subset of patients who can be weaned from support preoperatively have greater likelihood of survival.
研究体外膜肺氧合（ECMO）在小儿肺移植围手术期的支持效果。
回顾了 1990 年至 2008 年期间机构内小儿肺移植的数据库。
在研究期间，344 例患者接受了肺移植。344 例患者中有 33 例（9.6%）需要围手术期 ECMO 支持。15 例患者（中位数年龄 1.3 岁；范围，0.2-18 岁）需要进行 16 次移植前 ECMO 运行。适应证为呼吸衰竭（8/16，50%）、严重肺动脉高压（5/16，31%）和心肺崩溃（3/16，19%）。其中 4 例患者（27%）还需要术后支持。6 例患者（40%）在肺移植前成功撤机。6 例患者存活至出院。在肺移植前撤机的患者中，存活率更高（4/6，66%比 2/9，22%）。22 例患者（中位数年龄 9.4 岁；范围，0.2-21 岁）在肺移植后进行了 24 次 ECMO 运行。术后支持的适应证为原发性移植物功能障碍（18/24，75%）、肺炎（4/24，16%）和其他原因（2/24，9%）。肺移植与 ECMO 开始之间的中位时间为 32 小时（范围，0-1084 小时）；中位支持时间为 141 小时（范围，48-505 小时）。其中 5 例患者（23%）存活至出院。在死亡患者中，死因是难以控制的呼吸衰竭（12/17，70%）和感染性并发症（4/17，24%）。
围手术期 ECMO 支持的需求与接受肺移植的小儿患者的发病率和死亡率显著相关。能够在术前撤机的患者亚组有更大的生存可能性。
