Blanco Carlos, Steigman Carmen, Probst Nathan, Stroud Michael, Bhutta Adnan T, Dyamenahalli Umesh, Imamura Michiaki, Prodhan Parthak
From the *Department of Pediatric Cardiology, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; †Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; and ‡Department of Critical Care, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
ASAIO J. 2014 Mar-Apr;60(2):207-10. doi: 10.1097/MAT.0000000000000031.
Discrepancy between clinical and autopsy diagnosis in children supported on extracorporeal membrane oxygenation (ECMO) has not been previously described. To assess the utility of autopsy examination in children supported on ECMO and assess discrepancies between premortem and postmortem diagnosis in these patients. Retrospective chart review. General pediatric and cardiac intensive care units (ICUs) in a tertiary children's hospital. The hospital's ECMO database was queried for patients supported on ECMO from 2000 through 2010 who died and underwent autopsy examination. Fifty-four autopsies were performed in 139 nonsurvivors (28%) who required ECMO support in the pediatric and cardiac ICU. Major discrepancies between premortem and postmortem diagnoses were found in 29 patients (53.7%). The commonest missed diagnosis was myocardial infarction that occurred in 16 patients, followed by adrenal hemorrhage in three patients. Five patients with a cardiac diagnosis had both major (type 1 discrepancy) and minor (type 2 discrepancy) discrepancies. Surgical complications were noted in four postmortem study with three of them being class 1 discrepancy. We report significant discrepancy between autopsy and clinical findings among ECMO-supported pediatric patients. Our findings underscore the need for enhanced premorbid surveillance in patients supported on ECMO.
体外膜肺氧合（ECMO）支持下儿童临床诊断与尸检诊断之间的差异此前尚未见报道。目的是评估尸检在接受ECMO支持的儿童中的作用，并评估这些患者生前和死后诊断之间的差异。进行回顾性病历审查。研究对象为一家三级儿童医院的普通儿科和心脏重症监护病房（ICU）。查询该医院的ECMO数据库，找出2000年至2010年期间接受ECMO支持且死亡并接受尸检的患者。139名在儿科和心脏ICU需要ECMO支持的非幸存者中进行了54例尸检（28%）。在29名患者（53.7%）中发现生前和死后诊断存在重大差异。最常见的漏诊是16例患者发生的心肌梗死，其次是3例患者的肾上腺出血。5例心脏诊断患者同时存在重大（1型差异）和微小（2型差异）差异。在4例尸检研究中发现了手术并发症，其中3例为1级差异。我们报告了接受ECMO支持的儿科患者尸检与临床发现之间存在显著差异。我们的研究结果强调了对接受ECMO支持的患者加强病前监测的必要性。
