Ryerson Lindsay M, Guerra Gonzalo Garcia, Joffe Ari R, Robertson Charlene M T, Alton Gwen Y, Dinu Irina A, Granoski Don, Rebeyka Ivan M, Ross David B, Lequier Laurance
From the Department of Pediatrics (L.M.R., G.G.G., A.R.J., C.M.T.R., L.L.), Department of Public Health Sciences (I.A.D.), and Department of Surgery (I.M.R., D.B.R.), University of Alberta, Edmonton, Alberta, Canada; Pediatric Rehabilitation Outcomes Evaluation and Research Unit, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada (C.M.T.R., G.Y.A.); and Pediatric Critical Care Unit, Stollery Children's Hospital, Edmonton, Alberta, Canada (D.G.).
Circ Heart Fail. 2015 Mar;8(2):312-21. doi: 10.1161/CIRCHEARTFAILURE.114.001503. Epub 2015 Jan 9.
Survival after pediatric cardiac extracorporeal life support (ECLS) is guarded, and neurological morbidity varies widely. Our objective is to report our 10-year experience with cardiac ECLS, including survival and kindergarten entry neurocognitive outcomes; to identify predictors of mortality or adverse neurocognitive outcomes; and to compare 2 eras, before and after 2005.
From 2000 to 2009, 98 children had venoarterial cardiac ECLS. Sixty-four patients (65%) survived to hospital discharge, and 50 (51%) survived ≤5 years of age. Neurocognitive follow-up of survivors was completed at mean (SD) age of 52.9 (8) months using Wechsler Preschool and Primary Scale of Intelligence. Logistic regression analysis found the longer time (hours) for lactate to fall below 2 mmol/L on ECLS (hazard ratio, 1.39; 95% confidence interval, 1.05, 1.84; P=0.022), and the amount of platelets (mL/kg) given in the first 48 hours (hazard ratio, 1.18; 95% confidence interval, 1.06, 1.32; P=0.002) was independently associated with higher in-hospital mortality. Receiving ECLS after the year 2005 was independently associated with lower risk of in-hospital mortality (hazard ratio, 0.36; 95% confidence interval, 0.13, 0.99; P=0.048). Extracorporeal cardiopulmonary resuscitation was not independently associated with mortality or neurocognitive outcomes. Era was not independently associated with neurocognitive outcomes. The full-scale intelligence quotient of survivors without chromosomal abnormalities was 79.7 (16.6) with 25% below 2 SD of the population mean.
Mortality has improved over time; time for lactate to fall on ECLS and volume of platelets transfused are independent predictors of mortality. Extracorporeal cardiopulmonary resuscitation and era were not independently associated with neurocognitive outcomes.
小儿心脏体外膜肺氧合（ECLS）后的生存率难以预测，神经功能障碍的发生率差异很大。我们的目的是报告我们在心脏ECLS方面的10年经验，包括生存率和进入幼儿园时的神经认知结局；确定死亡率或不良神经认知结局的预测因素；并比较2005年之前和之后的两个时期。
2000年至2009年，98名儿童接受了静脉-动脉心脏ECLS。64例患者（65%）存活至出院，50例（51%）存活至5岁。使用韦氏学前和小学智力量表对存活者进行神经认知随访，平均（标准差）年龄为52.9（8）个月。逻辑回归分析发现，ECLS期间乳酸水平降至2 mmol/L以下的时间（小时）越长（风险比，1.39；95%置信区间，1.05，1.84；P=0.022），以及最初48小时内输注的血小板量（mL/kg）（风险比，1.18；95%置信区间，1.06，1.32；P=0.002）与较高的院内死亡率独立相关。2005年后接受ECLS与较低的院内死亡风险独立相关（风险比，0.36；95%置信区间，0.13，0.99；P=0.048）。体外心肺复苏与死亡率或神经认知结局无独立相关性。时期与神经认知结局无独立相关性。无染色体异常的存活者的全量表智商为79.7（16.6），25%低于人群均值的2个标准差。
随着时间的推移，死亡率有所改善；ECLS期间乳酸水平下降的时间和输注的血小板量是死亡率的独立预测因素。体外心肺复苏和时期与神经认知结局无独立相关性。
