Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia 30322, USA.
Ann Thorac Surg. 2012 Sep;94(3):874-9; discussion 879-80. doi: 10.1016/j.athoracsur.2012.04.040. Epub 2012 Jun 13.
Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to improve survival after in-hospital pediatric cardiac arrest. We describe our experience with ECPR for refractory cardiac arrest in pediatric cardiac patients.
We performed a retrospective analysis of the use of venoarterial extracorporeal membrane oxygenation (ECMO) for in-hospital cardiac arrest from 2002 to 2011. The primary endpoint was survival to discharge, and the secondary endpoint was long-term functional neurologic status.
Of 160 total uses of cardiac ECMO in 159 patients, 90 (56%) were ECPR (mean age 2.05 years; range, 0 days to 16.5 years). Sixty-four patients (71%) were postoperative, of which 36 were single ventricle and 28 were biventricular. Nine patients (10%) had cardiomyopathy-myocarditis, and 17 patients (19%) were nonpostoperative (5 single ventricle; 12 biventricular). Fifty-nine patients (66%) had open chest cannulation, and 31 (34%) had peripheral cannulation. Fifty patients (56%) survived to discharge. Duration of ECMO was 4.3±4.0 days (median 3) for survivors and 6.3±5.4 days (median 5) for nonsurvivors (p<0.05). On follow-up, almost half of survivors without genetic syndromes had normal neurologic status.
Extracorporeal cardiopulmonary resuscitation is an appropriate application of ECMO in pediatric cardiac patients. We report overall survival of 56%. Cardiomyopathy patients have favorable outcomes (89% survival). Biventricular patients have better outcomes then single ventricle patients (p<0.01). Extracorporeal cardiopulmonary resuscitation also seems to be a good strategy for nonpostoperative patients (71% survival). Nearly half of postoperative patients (46%) resuscitated with ECPR survived to hospital discharge.
体外心肺复苏（ECPR）已被证明可提高院内儿科心搏骤停后的存活率。我们描述了我们在儿科心脏患者难治性心搏骤停中使用 ECPR 的经验。
我们对 2002 年至 2011 年期间因院内心搏骤停而使用静脉动脉体外膜氧合（ECMO）的情况进行了回顾性分析。主要终点是出院存活率，次要终点是长期功能神经状态。
在 159 例患者的 160 次心脏 ECMO 总应用中，90 例（56%）为 ECPR（平均年龄 2.05 岁；范围 0 天至 16.5 岁）。64 例（71%）为术后患者，其中 36 例为单心室，28 例为双心室。9 例（10%）患有心肌病-心肌炎，17 例（19%）为非术后患者（5 例单心室；12 例双心室）。59 例（66%）患者行开胸插管，31 例（34%）患者行外周插管。50 例（56%）患者存活至出院。幸存者的 ECMO 持续时间为 4.3±4.0 天（中位数 3），而非幸存者为 6.3±5.4 天（中位数 5）（p<0.05）。在随访中，没有遗传综合征的幸存者中近一半的神经状态正常。
体外心肺复苏是儿科心脏患者 ECMO 的一种合适应用。我们报告的总存活率为 56%。心肌病患者的预后良好（89%的存活率）。双心室患者的预后优于单心室患者（p<0.01）。体外心肺复苏对于非术后患者似乎也是一种很好的策略（71%的存活率）。近一半（46%）经 ECPR 复苏的术后患者存活至出院。
