Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT, USA.
J Pediatr Surg. 2013 Jul;48(7):1509-13. doi: 10.1016/j.jpedsurg.2012.10.052.
Abdominal compartment syndrome (ACS) may complicate ECMO due to significant fluid shifts resulting in tense ascites and interstitial edema. This compromises venous cannula flow leading to inadequate patient support. It is debatable whether decompressive laparotomy should be performed in these patients due to the risk of bleeding and poor prognosis. We sought to evaluate the effect of decompressive laparotomy on ECMO support and patient survival.
We reviewed our tertiary care children's hospital ECMO registry (2000-2011) identifying those who underwent decompressive laparotomy. All had ACS as characterized by abdominal hypertension with abdominal distention, hemodynamic instability, oliguria, rising central venous pressures, and inadequate venous return to the ECMO circuit. Physiologic parameters immediately before and 60 min after laparotomy were compared using a signed rank test.
Seven patients were identified. ACS developed within 8 h of initiating ECMO in 6 patients. Decompressive laparotomy resulted in significant improvement of patient physiologic parameters and ECMO venous return. One patient had significant bleeding following laparotomy. There were no survivors but three were organ donation candidates after stabilization via decompressive laparotomy.
Decompressive laparotomy for ACS in patients on ECMO markedly improves support and tissue perfusion. While in our series ECMO complicated by ACS carries a poor prognosis, we cannot confidently define this as futile therapy due to the limited sample size.
由于大量液体转移导致紧张性腹水和间质水肿，腹室间隔综合征（ACS）可能使 ECMO 复杂化。这会影响静脉插管的血流，导致患者支持不足。由于出血风险和预后不良，对于这些患者是否应进行减压剖腹术存在争议。我们试图评估减压剖腹术对 ECMO 支持和患者生存的影响。
我们回顾了我们的三级儿童保健医院 ECMO 注册中心（2000-2011 年），确定了接受减压剖腹术的患者。所有患者均表现为 ACS，其特征为腹压升高伴腹部膨隆、血流动力学不稳定、少尿、中心静脉压升高和 ECMO 回路静脉回流不足。使用符号秩检验比较剖腹术前和术后 60 分钟的生理参数。
确定了 7 名患者。6 名患者在启动 ECMO 后 8 小时内发生 ACS。减压剖腹术显著改善了患者的生理参数和 ECMO 静脉回流。1 名患者在剖腹术后出现大量出血。尽管经过减压剖腹术稳定后，有 3 名患者成为了器官捐献候选人，但没有幸存者。
对于 ECMO 上的 ACS 患者进行减压剖腹术可显著改善支持和组织灌注。虽然在我们的研究中，ACS 并发 ECMO 的预后较差，但由于样本量有限，我们不能确定这是无效的治疗方法。
