University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA.
Ann Thorac Surg. 2013 Feb;95(2):656-61. doi: 10.1016/j.athoracsur.2012.06.041. Epub 2012 Aug 24.
Extracorporeal membrane oxygenation (ECMO) is the most common form of cardiac support for postcardiotomy cardiac failure in children. While its benefits have been thoroughly explored in infants weighing more than 3 kg, similar analyses are lacking in lower weight neonates. This single-center study investigated outcomes and risks for poor survival among infants weighing 3 kg or less.
A retrospective review of infants 3 kg or less who required postcardiotomy ECMO support was performed (January 1, 1999 to December 31, 2010). Primary outcome was 30-day survival after decannulation. Factors analyzed for association with poor outcome included demographics, cardiac anatomy, bypass and circulatory arrest times, total ECMO support time, postoperative lactate, inotrope use, and need for renal replacement therapy.
During the study period, 64 patients weighing 3 kg or less required postcardiotomy ECMO. Median gestational age and age at ECMO initiation were 38 weeks (interquartile range, 36 to 39) and 7 days (interquartile range, 4 to 9), respectively, with median ECMO support time of 164 hours (interquartile range, 95 to 231). Overall 30-day survival after decannulation was 33%. Factors associated with poor outcome were longer duration of support (231 hours or more, 12% survival, versus less than 231 hours, 40% survival; p = 0.05) and renal replacement therapy (n = 36, survival 17% versus 54%; p = 0.002). Multivariable regression analysis identified renal replacement therapy as the only independent factor associated with poor survival (odds ratio 4.3, 95% confidence interval: 1.3 to 14.9, p = 0.02).
For infants weighing 3 kg or less, 30-day survival after decannulation after cardiac ECMO is poor. Factors associated with poor prognosis were need for renal replacement therapy and longer duration of ECMO support. These findings may provide a useful guide for medical decision making among this unique, high-risk patient group.
体外膜肺氧合（ECMO）是小儿心脏手术后心功能衰竭最常用的心脏支持方式。虽然在体重超过 3 公斤的婴儿中已经对其益处进行了深入研究，但在体重较低的新生儿中缺乏类似的分析。本单中心研究旨在探讨体重 3 公斤或以下的婴儿接受心脏手术后 ECMO 支持的生存情况和不良预后的危险因素。
对 1999 年 1 月 1 日至 2010 年 12 月 31 日期间需要心脏手术后 ECMO 支持的体重 3 公斤或以下的婴儿进行回顾性研究。主要转归为拔管后 30 天的生存率。分析与不良预后相关的因素包括人口统计学、心脏解剖结构、体外循环和停循环时间、总 ECMO 支持时间、术后乳酸、儿茶酚胺使用和需要肾脏替代治疗。
在研究期间，64 名体重 3 公斤或以下的患儿需要心脏手术后 ECMO 支持。中位胎龄和 ECMO 开始时的年龄分别为 38 周（四分位距 36 至 39）和 7 天（四分位距 4 至 9），ECMO 支持时间的中位数为 164 小时（四分位距 95 至 231）。拔管后 30 天的总体生存率为 33%。与预后不良相关的因素包括支持时间较长（231 小时或以上，12%的生存率，与 231 小时以下，40%的生存率；p=0.05）和肾脏替代治疗（n=36，生存率 17%与 54%；p=0.002）。多变量回归分析确定肾脏替代治疗是与不良生存相关的唯一独立因素（比值比 4.3，95%置信区间：1.3 至 14.9，p=0.02）。
对于体重 3 公斤或以下的婴儿，心脏 ECMO 后拔管后 30 天的生存率较差。与预后不良相关的因素包括需要肾脏替代治疗和 ECMO 支持时间较长。这些发现可为这一独特、高危患者群体的医疗决策提供有用的指导。
