Division of Pediatric Critical Care, Department of Pediatrics, Primary Children's Medical Center, University of Utah, Salt Lake City, UT,USA.
Crit Care Med. 2011 Feb;39(2):364-70. doi: 10.1097/CCM.0b013e3181fb7b35.
The last multicentered analysis of extracorporeal membrane oxygenation in pediatric acute respiratory failure was completed in 1993. We reviewed recent international data to evaluate survival and predictors of mortality.
Retrospective case series review.
The Extracorporeal Life Support Organization Registry, which includes data voluntarily submitted from over 115 centers worldwide, was queried. The work was completed at the Division of Pediatric Critical Care, Department of Pediatrics, Primary Children's Medical Center, University of Utah, Salt Lake City, UT.
Patients aged 1 month to 18 yrs supported with extracorporeal membrane oxygenation for acute respiratory failure from 1993 to 2007.
None.
There were 3,213 children studied. Overall survival remained relatively unchanged over time at 57%. Considerable variability in survival was found based on pulmonary diagnosis, ranging from 83% for status asthmaticus to 39% for pertussis. Comorbidities significantly decreased survival to 33% for those with renal failure (n = 329), 16% with liver failure (n = 51), and 5% with hematopoietic stem cell transplantation (n = 22). The proportion of patients with comorbidities increased from 19% during 1993 to 47% in 2007. Clinical factors associated with mortality included precannulation ventilatory support longer than 2 wks and lower precannulation blood pH.
Although the survival of pediatric patients with acute respiratory failure treated with extracorporeal membrane oxygenation has not changed, this treatment is currently offered to increasingly medically complex patients. Mechanical ventilation in excess of 2 wks before the initiation of extracorporeal membrane oxygenation is associated with decreased survival.
1993 年完成了最后一次小儿急性呼吸衰竭体外膜氧合的多中心分析。我们回顾了最近的国际数据，以评估存活率和死亡率预测因素。
回顾性病例系列分析。
体外生命支持组织登记处，该登记处包括来自全球 115 个以上中心自愿提交的数据，对此进行了查询。这项工作是在犹他大学盐湖城初级儿童医疗中心儿科危重病学分部完成的。
1993 年至 2007 年期间因急性呼吸衰竭接受体外膜氧合治疗的 1 个月至 18 岁儿童。
无。
共研究了 3213 例患儿。总体存活率在时间上相对保持不变，为 57%。根据肺部诊断，存活率存在显著差异，从哮喘状态的 83%到百日咳的 39%不等。合并症使存活率显著下降，肾衰竭患儿（n=329）为 33%，肝衰竭患儿（n=51）为 16%，造血干细胞移植患儿（n=22）为 5%。合并症患儿的比例从 1993 年的 19%增加到 2007 年的 47%。与死亡率相关的临床因素包括体外膜氧合前机械通气支持超过 2 周和较低的体外膜氧合前血 pH 值。
尽管接受体外膜氧合治疗的小儿急性呼吸衰竭患者的存活率没有改变，但目前该治疗方法用于越来越多的患有多种合并症的患者。在开始体外膜氧合前机械通气超过 2 周与存活率降低相关。
