Department of Clinical Engineering, Hirosaki University School of Medicine and Hospital, Hirosaki, Aomori, Japan.
Artif Organs. 2011 Nov;35(11):1002-9. doi: 10.1111/j.1525-1594.2011.01374.x.
Extracorporeal membrane oxygenation (ECMO) is widely used for circulatory support in pediatric cardiac patients with low cardiac output and hypoxemia. We retrospectively evaluated the efficacy of ECMO support for respiratory and heart failure in infants and children. From April 2002 to February 2011, 14 patients aged 19 days to 20 years old (average 44 months), with body weight 2.6 kg to 71 kg (median 14.1 kg), underwent ECMO support for failing cardiac function, hypoxemia, and low cardiac output syndrome. In 12 patients, ECMO was introduced after operation for congenital heart disease (four with complete repair including Fontan circulation, and eight with palliative repair). In one patient, ECMO was introduced after partial pulmonary resection for congenital cystic adenomatoid malformation because of respiratory failure. ECMO was introduced in a patient with severe heart failure caused by fulminant myocarditis. Patients' demographics, duration of extracorporeal membrane oxygenation, additional support, and outcomes were analyzed. Ten patients (71%) were successfully weaned from ECMO, and eight patients (57%) were discharged from the hospital. The mean duration of ECMO support was 332 h (range 11-2030 h). Although management of the ECMO circuit, including anticoagulation (activated clotting time: 150-250), was conducted following the institutional practice guidelines, it was difficult to control the bleeding. Seven patients required renal replacement therapy during ECMO support using peritoneal dialysis or continuous hemodiafiltration. Five patients had additional operative procedures: systemic-pulmonary shunt in two, bidirectional Glenn takedown with right modified Blalock-Taussig shunt, total cavopulmonary connection takedown, and redo ECMO in one patient each. The patient who had the longest ECMO support for respiratory failure due to acute respiratory distress syndrome after lung surgery was successfully weaned from ECMO because high-frequency oscillation (HFO) improved respiratory function. ECMO for heart and respiratory failure in infants and children is effective and allows time for recovery of cardiac dysfunction and acute hypoxic insult. The long-term ECMO support for over 2000 h was very rare, but it was possible to wean this patient from ECMO using HFO.
体外膜肺氧合（ECMO）广泛应用于伴有低心输出量和低氧血症的儿科心脏病患者的循环支持。我们回顾性评估了 ECMO 支持在婴儿和儿童呼吸和心力衰竭中的疗效。从 2002 年 4 月至 2011 年 2 月，14 名年龄 19 天至 20 岁（平均 44 个月）、体重 2.6kg 至 71kg（中位数 14.1kg）的患者因心功能衰竭、低氧血症和低心输出量综合征接受 ECMO 支持。在 12 例患者中，ECMO 是在先天性心脏病手术后引入的（包括 Fontan 循环的 4 例完全修复和 8 例姑息性修复）。在 1 例因先天性囊性腺瘤样畸形行部分肺切除术导致呼吸衰竭的患者中，ECMO 是在术后引入的。1 例暴发性心肌炎导致严重心力衰竭的患者接受 ECMO 治疗。分析了患者的人口统计学、体外膜肺氧合时间、辅助治疗和结局。10 例（71%）患者成功脱离 ECMO，8 例（57%）患者出院。ECMO 支持的平均时间为 332 小时（范围 11-2030 小时）。尽管按照机构实践指南进行 ECMO 回路的管理，包括抗凝（激活凝血时间：150-250），但很难控制出血。7 例患者在 ECMO 支持期间需要肾脏替代治疗，使用腹膜透析或连续血液滤过透析。5 例患者进行了额外的手术：2 例全身-肺分流术，2 例双向 Glenn 拆除术伴右侧改良 Blalock-Taussig 分流术，1 例全腔静脉-肺动脉连接拆除术，1 例再次 ECMO。1 例因肺手术后急性呼吸窘迫综合征导致呼吸衰竭而接受最长 ECMO 支持的患者成功脱离 ECMO，因为高频振荡（HFO）改善了呼吸功能。ECMO 在心和呼吸衰竭的婴儿和儿童中是有效的，并为心脏功能障碍和急性缺氧损伤的恢复提供了时间。2000 小时以上的长期 ECMO 支持非常罕见，但通过 HFO 可以使该患者脱离 ECMO。
