Division of Pediatric Surgery at Primary Children's Medical Center, Department of Surgery, University of Utah, Salt Lake City, Utah 84113, USA.
J Pediatr Surg. 2012 Dec;47(12):2239-43. doi: 10.1016/j.jpedsurg.2012.09.014.
We have previously reported the use of EC-CPR for the treatment of hypothermic cardiac arrest with an overall survival of 50%. As we have continued this protocol for an additional 5 years, we sought to update this information.
We reviewed all of the activations for hypothermic cardiac arrest from 2005 to 2011. Results are presented as means with minimum and maximum values. The 95% confidence interval for the point estimate of survival was calculated using a binomial distribution.
Nine children were placed on EC-CPR for hypothermic cardiac arrest. Two patients survived to discharge and were neurologically normal. The other seven patients were adequately supported with veno-arterial EC-CPR but met brain death criteria after rewarming prompting withdrawal of support. Four of these went on to multiple organ donation. The overall survival in the series was 22% with a 95% confidence interval from 4% to 58%.
Cold water drowning and avalanche suffocations cause dramatic hypothermic cardiac arrests in previously robust children. A protocolized rapid response with EC-CPR can save some of these children despite prolonged periods of cardiac arrest prior to initiation of bypass. The overall survival rate is likely less than our prior more optimistic report suggested.
我们之前曾报道过使用体外心肺复苏（EC-CPR）治疗低体温性心脏骤停的情况，总体存活率为 50%。随着我们继续使用该方案治疗 5 年，我们希望更新相关信息。
我们回顾了 2005 年至 2011 年所有低体温性心脏骤停的激活情况。结果以最小值和最大值的平均值表示。使用二项式分布计算生存率点估计的 95%置信区间。
9 名儿童因低体温性心脏骤停接受了 EC-CPR。2 名患者存活出院且神经功能正常。其他 7 名患者在接受静脉-动脉 EC-CPR 支持下得到充分支持，但在复温后符合脑死亡标准，随后停止支持。其中 4 名患者进行了多器官捐献。该系列的总体生存率为 22%，95%置信区间为 4%至 58%。
冷水溺水和雪崩窒息会导致原本健壮的儿童发生严重的低体温性心脏骤停。尽管在开始体外循环之前心脏骤停时间较长，但通过制定快速反应方案和使用 EC-CPR 可以挽救其中一些儿童的生命。总体生存率可能低于我们之前更乐观的报告所提示的水平。
