Division of Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
Pediatr Crit Care Med. 2012 Jul;13(4):e249-54. doi: 10.1097/PCC.0b013e31824176f4.
Extracorporeal membrane oxygenation is used to support children with respiratory failure. When extracorporeal membrane oxygenation duration is prolonged, decisions regarding ongoing support are difficult as a result of limited prognostic data.
Retrospective case series.
Multi-institutional data reported to the Extracorporeal Life Support Organization Registry.
Patients aged 1 month to 18 yrs supported with extracorporeal membrane oxygenation for respiratory failure from 1993 to 2007 who received support for ≥ 21 days.
None.
Of the 3213 children supported with extracorporeal membrane oxygenation during the study period, 389 (12%) were supported ≥ 21 days. Median patient age was 9.1 months (interquartile range, 2.5-41.7 months). Median weight was 6.7 kg (interquartile range, 3.5-15.8 kg). Survival for this group was 38%, significantly lower than survival reported for children supported ≤ 14 days (61%, p < .001). Among children supported with extracorporeal membrane oxygenation for ≥ 21 days, no differences were found between survivors and nonsurvivors with regard to acute pulmonary diagnosis, pre-extracorporeal membrane oxygenation comorbidities, pre-extracorporeal membrane oxygenation adjunctive therapies, or pre-extracorporeal membrane oxygenation blood gas parameters. Only peak inspiratory pressure was significantly different in survivors. Complications occurring on extracorporeal membrane oxygenation were more common among nonsurvivors. The use of inotropic infusion (odds ratio 1.64; 95% confidence interval 1.07-2.52), acidosis (pH <7.2) during extracorporeal membrane oxygenation (odds ratio 2.62; 95% confidence interval 1.51-4.55), and male gender (odds ratio 1.95; 95% confidence interval 1.21-3.15) were independently associated with increased odds of death.
Survival declines with duration of extracorporeal membrane oxygenation. Male gender and inadequate cardiorespiratory status during extracorporeal membrane oxygenation increased the risk of death. Prolonged support with extracorporeal membrane oxygenation appears reasonable unless multiorgan failure develops.
体外膜肺氧合用于支持呼吸衰竭的儿童。当体外膜肺氧合持续时间延长时，由于预后数据有限，关于持续支持的决策变得困难。
回顾性病例系列。
向体外生命支持组织登记处报告的多机构数据。
1993 年至 2007 年间接受体外膜肺氧合支持治疗呼吸衰竭的年龄在 1 个月至 18 岁之间的患者，体外膜肺氧合支持时间≥21 天。
无。
在研究期间接受体外膜肺氧合支持的 3213 名儿童中，389 名（12%）接受支持时间≥21 天。中位患者年龄为 9.1 个月（四分位距，2.5-41.7 个月）。中位体重为 6.7 公斤（四分位距，3.5-15.8 公斤）。该组的存活率为 38%，明显低于接受≤14 天支持的儿童（61%，p<0.001）。在接受体外膜肺氧合支持时间≥21 天的儿童中，幸存者和非幸存者之间在急性肺诊断、体外膜肺氧合前合并症、体外膜肺氧合辅助治疗或体外膜肺氧合前血气参数方面无差异。仅幸存者的吸气峰压有显著差异。非幸存者发生的并发症更为常见。体外膜肺氧合期间使用正性肌力输注（比值比 1.64；95%置信区间 1.07-2.52）、酸中毒（pH<7.2）（比值比 2.62；95%置信区间 1.51-4.55）和男性（比值比 1.95；95%置信区间 1.21-3.15）与死亡风险增加独立相关。
体外膜肺氧合持续时间延长与生存率下降有关。体外膜肺氧合期间男性性别和心肺功能不足增加了死亡风险。除非多器官衰竭发生，否则延长体外膜肺氧合支持似乎是合理的。
