From the *Department of Pediatrics, Division of Pediatric Critical Care, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas; †Department of Pediatrics, Division of Pediatric Cardiology, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas; ‡Department of Pediatrics, Division of Biostatistics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas; §The Extracorporeal Life Support Organization Registry, Ann Arbor, Michigan; and ¶Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, Utah.
ASAIO J. 2014 Jan-Feb;60(1):49-56. doi: 10.1097/MAT.0000000000000013.
Overwhelming adenovirus infection requiring extracorporeal membrane oxygenation (ECMO) support carries a high mortality in pediatric patients. The objective of this study was to retrospectively review data from the Extracorporeal Life Support Organization (ELSO) registry for pediatric patients with adenovirus infection and define for this patient cohort: 1) clinical characteristics, 2) survival to hospital discharge, and 3) factors associated with mortality before hospital discharge. In this retrospective registry study, pediatric patients with adenovirus infection requiring ECMO support identified in an international ECMO registry from 1998 to 2009 were compared for clinical characteristics (demographics, pre-ECMO variables, and complications on ECMO) between survivors and nonsurvivors to hospital discharge. Descriptive statistics and univariate and multivariate logistic analysis were used to compare clinical characteristics among survivors and nonsurvivors. For children requiring ECMO support for adenovirus, the survival at hospital discharge is 38% (62/163). Among neonates (<31 days of age), the survival at hospital discharge was only 11% (6/54). Among patient factors, neonatal age (odds ratio [OR], 4.3; 95% confidence interval [CI], 1.62-10.87), a decrease of 0.1 unit in pre-ECMO pH (OR, 1.77; 95% CI, 1.3-2.42), the presence of sepsis (OR, 4.55; 95% CI, 1.47-14.15), and increased peak inspiratory pressures (OR, 1.04; 95% CI, 1.01-1.08) were all independently associated with in-hospital mortality. ECMO complications independently associated with in-hospital mortality were presence of pneumothorax (OR, 3.57; 95% CI, 1.19-10.7), pH less than 7.2 (OR, 5.94; 95% CI, 1.04-34.1), and central nervous system hemorrhage (OR, 25.36; 95% CI, 1.47-436.7). In this retrospective cohort study of pediatric patients with adenovirus infection supported on ECMO, survival to hospital discharge was 38% but was much lower in neonates. Neonatal presentation, degree of acidosis, sepsis, and increased PIP are factors present before decisions are made regarding a trial of ECMO, whereas pneumothorax and brain hemorrhage were ECMO-related complications independently associated with mortality.
腺病毒感染导致需要体外膜肺氧合 (ECMO) 支持的情况在儿科患者中死亡率很高。本研究的目的是回顾性分析 1998 年至 2009 年期间体外生命支持组织 (ELSO) 登记处的儿科腺病毒感染患者的数据，并为该患者群体定义以下内容：1）临床特征，2）医院出院存活率，以及 3）与医院出院前死亡率相关的因素。在这项回顾性登记研究中，对国际 ECMO 登记处中需要 ECMO 支持的腺病毒感染的儿科患者进行比较，比较幸存者和非幸存者的临床特征（人口统计学、ECMO 前变量和 ECMO 期间的并发症），直至医院出院。使用描述性统计和单变量及多变量逻辑分析比较幸存者和非幸存者的临床特征。对于因腺病毒而需要 ECMO 支持的儿童，医院出院时的存活率为 38%（62/163）。在新生儿（<31 天龄）中，医院出院时的存活率仅为 11%（6/54）。在患者因素中，新生儿年龄（比值比 [OR]，4.3；95%置信区间 [CI]，1.62-10.87）、ECMO 前 pH 值降低 0.1 单位（OR，1.77；95%CI，1.3-2.42）、败血症（OR，4.55；95%CI，1.47-14.15）和吸气峰压升高（OR，1.04；95%CI，1.01-1.08）均与院内死亡率独立相关。与院内死亡率独立相关的 ECMO 并发症为气胸（OR，3.57；95%CI，1.19-10.7）、pH 值低于 7.2（OR，5.94；95%CI，1.04-34.1）和中枢神经系统出血（OR，25.36；95%CI，1.47-436.7）。在这项对接受 ECMO 支持的儿科腺病毒感染患者的回顾性队列研究中，医院出院时的存活率为 38%，但新生儿的存活率要低得多。新生儿表现、酸中毒程度、败血症和升高的 PIP 是在决定进行 ECMO 试验之前存在的因素，而气胸和脑出血是与死亡率独立相关的 ECMO 相关并发症。
