Philip Joseph, Burgman Cole, Bavare Aarti, Akcan-Arikan Ayse, Price Jack F, Adachi Iki, Shekerdemian Lara S
Congenital Heart Center, Shands Children's Hospital, University of Florida, Gainsville, Fla.
Section of Critical Care and Congenital Heart Surgery, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
J Thorac Cardiovasc Surg. 2014 Nov;148(5):2367-72. doi: 10.1016/j.jtcvs.2014.03.023. Epub 2014 Mar 21.
To describe the use of extracorporeal membrane oxygenation (ECMO) in acute resuscitation after cardiac arrest in pediatric patients with heart disease, with reference to patient selection and predictors of outcome.
A retrospective medical record review was performed of all patients aged ≤21 years with heart disease who had undergone ECMO for cardiopulmonary resuscitation (ECPR) at Texas Children's Hospital from January 2005 to December 2012. The most recent Pediatric Overall Performance Category score was determined from the patients' medical records.
During the study period, 62 episodes of ECPR occurred in 59 patients, with 27 (46%) surviving to hospital discharge and 25 (43%) alive at the most recent follow-up visit. The overall survival to discharge for patients with myocardial failure (myocarditis, cardiomyopathy, or after transplantation) and structural heart disease was similar (40% vs 50%, P=.6). No patient with restrictive cardiomyopathy survived; 1 patient (13%) in ECPR group after late cardiac graft failure survived to discharge. Survival to discharge was greater for patients who were intubated (70%) at cardiac arrest (P=.001). The presence of pre-existing acute kidney injury at cardiac arrest (62%) was associated with greater mortality (P=.059). A Pediatric Overall Performance Category score of ≤2 (indicating good neurologic performance) was present in 68% of the survivors; 7 patients (87%) with a score>2 had abnormal imaging findings (P=.01).
ECPR was associated with modest survival in pediatric patients with heart disease; however, this was associated in part with the underlying disease and pre-existing comorbidities, including the presence of acute kidney injury.
描述体外膜肺氧合（ECMO）在患有心脏病的儿科患者心脏骤停后急性复苏中的应用，并参考患者选择和预后预测因素。
对2005年1月至2012年12月在德克萨斯儿童医院接受体外膜肺氧合心肺复苏（ECPR）的所有年龄≤21岁的心脏病患者进行回顾性病历审查。根据患者病历确定最新的儿科总体表现类别评分。
在研究期间，59例患者发生了62次ECPR事件，其中27例（46%）存活至出院，25例（43%）在最近一次随访时仍存活。心肌衰竭（心肌炎、心肌病或移植后）患者和结构性心脏病患者的总体出院生存率相似（40%对50%，P = 0.6）。限制性心肌病患者无一存活；心脏移植晚期失败后ECPR组中有1例患者（13%）存活至出院。心脏骤停时已插管的患者出院生存率更高（70%）（P = 0.001）。心脏骤停时存在既往急性肾损伤（62%）与更高的死亡率相关（P = 0.059）。68%的幸存者儿科总体表现类别评分为≤2（表明神经功能良好）；7例评分>2的患者（87%）有异常影像学表现（P = 0.01）。
ECPR与患有心脏病的儿科患者的适度生存率相关；然而，这部分与潜在疾病和既往合并症有关，包括急性肾损伤的存在。
