Roeleveld Peter P, Wilde Rob de, Hazekamp Mark, Rycus Peter T, Thiagarajan Ravi R
Pediatric Intensive Care, Leiden University Medical Center, the Netherlands
Pediatric Intensive Care, Leiden University Medical Center, the Netherlands.
World J Pediatr Congenit Heart Surg. 2014 Jul;5(3):393-7. doi: 10.1177/2150135114526420.
Describing outcomes for children with hypoplastic left heart syndrome (HLHS) undergoing hybrid palliation (pulmonary artery band and stent placement in the patent ductus arteriosus) requiring extracorporeal membrane oxygenation (ECMO) support for cardiorespiratory failure.
We reviewed the Extracorporeal Life Support Organization database for all patients with a diagnosis of an HLHS undergoing hybrid stage 1 palliation supported with ECMO and those patients with hybrid palliation supported with ECMO after comprehensive stage 2 palliation. Patients were identified using a combination of International Classification of Diseases, Ninth Revision and registry diagnosis and procedure codes. We report survival to hospital discharge and ECMO complications.
We identified 44 patients with HLHS requiring ECMO following stage 1 hybrid approach. Median age at cannulation was 13.5 days. Only 16% survived to hospital discharge. In all, 20 (50%) patients had a cardiac arrest prior to going onto ECMO and for 3 (19%) patients, ECMO was initiated during cardiopulmonary resuscitation.
Overall survival for ECMO support in patients with HLHS palliated via the hybrid approach is very poor (16%) and is worse than 31% survival reported for ECMO after conventional stage 1 palliation. The reasons for these poor outcomes require further investigation.
描述患有左心发育不全综合征（HLHS）的儿童在接受混合姑息治疗（肺动脉环扎术及动脉导管未闭内支架置入术）后，因心肺功能衰竭需要体外膜肺氧合（ECMO）支持的治疗结果。
我们回顾了体外生命支持组织数据库，纳入所有诊断为HLHS且在ECMO支持下接受一期混合姑息治疗的患者，以及在二期综合姑息治疗后接受ECMO支持的混合姑息治疗患者。通过国际疾病分类第九版及登记诊断和手术编码相结合的方式识别患者，并报告出院生存率及ECMO并发症情况。
我们确定了44例在一期混合治疗后需要ECMO的HLHS患者。插管时的中位年龄为13.5天。只有16%的患者存活至出院, 共有20例（50%）患者在接受ECMO之前发生心脏骤停，3例（19%）患者在心肺复苏期间开始使用ECMO。
通过混合方法进行姑息治疗的HLHS患者接受ECMO支持的总体生存率非常低（16%），低于传统一期姑息治疗后ECMO报告的31%的生存率。这些不良结果的原因需要进一步调查。
