Gupta Punkaj, DasGupta Rahul, Best Derek, Chu Craig B, Elsalloukh Hassan, Gossett Jeffrey M, Imamura Michiaki, Butt Warwick
1Department of Pediatrics,Division of Pediatric Cardiology,University of Arkansas for Medical Sciences,Little Rock,United States of America.
2Department of Anesthesia,Division of Pediatric Anesthesiology,University of Arkansas for Medical Sciences,Little Rock,United States of America.
Cardiol Young. 2015 Feb;25(2):248-54. doi: 10.1017/S1047951113002011. Epub 2013 Dec 17.
There are limited data on the outcomes of children receiving delayed (≥7 days) extracorporeal membrane oxygenation after cardiac surgery. The primary aim of this project is to identify the aetiology and outcomes of extracorporeal membrane oxygenation in children receiving delayed (≥7 days) extracorporeal membrane oxygenation after cardiac surgery.
We conducted a retrospective review of all children ≤18 years supported with delayed extracorporeal membrane oxygenation after cardiac surgery between the period January, 2001 and March, 2012 at the Arkansas Children's Hospital, United States of America, and Royal Children's Hospital, Australia. The data collected in our study included patient demographic information, diagnoses, extracorporeal membrane oxygenation indication, extracorporeal membrane oxygenation support details, medical and surgical history, laboratory, microbiological, and radiographic data, information on organ dysfunction, complications, and patient outcomes. The outcome variables evaluated in this report included: survival to hospital discharge and current survival with emphasis on neurological, renal, pulmonary, and other end-organ function.
During the study period, 423 patients undergoing cardiac surgery were supported with extracorporeal membrane oxygenation at two institutions, with a survival of 232 patients (55%). Of these, 371 patients received extracorporeal membrane oxygenation <7 days after cardiac surgery, with a survival of 205 (55%) patients, and 52 patients received extracorporeal membrane oxygenation ≥7 days after cardiac surgery, with a survival of 27 (52%) patients. The median duration of extracorporeal membrane oxygenation run for the study cohort was 5 days (interquartile range: 3, 10). In all, 14 patients (25%) received extracorporeal membrane oxygenation during active cardiopulmonary resuscitation with chest compressions. There were 24 patients (44%) who received dialysis while being on extracorporeal membrane oxygenation. There were eight patients (15%) who had positive blood cultures and four patients (7%) who had positive urine cultures while being on extracorporeal membrane oxygenation. There were nine patients (16%) who had bleeding complications associated with extracorporeal membrane oxygenation runs. There were 10 patients (18%) who had cerebrovascular thromboembolic events associated with extracorporeal membrane oxygenation runs. Of these, 19 patients are still alive with significant comorbidities.
This study demonstrates that mortality outcomes are comparable among children receiving extracorporeal membrane oxygenation ≥7 days and <7 days after cardiac surgery. The proportion of patients receiving extracorporeal membrane oxygenation ≥7 days is small and the aetiology diverse.
关于心脏手术后接受延迟（≥7天）体外膜肺氧合治疗的儿童的预后数据有限。本项目的主要目的是确定心脏手术后接受延迟（≥7天）体外膜肺氧合治疗的儿童体外膜肺氧合治疗的病因及预后。
我们对2001年1月至2012年3月期间在美国阿肯色儿童医院和澳大利亚皇家儿童医院接受心脏手术后延迟体外膜肺氧合治疗的所有18岁及以下儿童进行了回顾性研究。我们研究中收集的数据包括患者人口统计学信息、诊断、体外膜肺氧合治疗指征、体外膜肺氧合治疗支持细节、医疗和手术史、实验室、微生物学和影像学数据、器官功能障碍、并发症及患者预后信息。本报告评估的结局变量包括：出院生存率及目前生存率，重点关注神经、肾脏、肺部及其他终末器官功能。
在研究期间，两家机构共有423例接受心脏手术的患者接受了体外膜肺氧合治疗，232例患者存活（55%）。其中，371例患者在心脏手术后<7天接受了体外膜肺氧合治疗，205例（55%）患者存活；52例患者在心脏手术后≥7天接受了体外膜肺氧合治疗，27例（52%）患者存活。研究队列体外膜肺氧合治疗的中位持续时间为5天（四分位间距：3，10）。总共有14例患者（25%）在进行胸外按压的心肺复苏期间接受了体外膜肺氧合治疗。有24例患者（44%）在接受体外膜肺氧合治疗期间接受了透析。有8例患者（15%）在接受体外膜肺氧合治疗期间血培养呈阳性，4例患者（7%）尿培养呈阳性。有9例患者（16%）发生了与体外膜肺氧合治疗相关的出血并发症。有10例患者（18%）发生了与体外膜肺氧合治疗相关的脑血管血栓栓塞事件。其中，19例患者仍存活且伴有严重合并症。
本研究表明，心脏手术后接受体外膜肺氧合治疗≥7天和<7天的儿童的死亡率结局相当。接受体外膜肺氧合治疗≥7天的患者比例较小且病因多样。
