Nading J H
Department of Pediatrics, Naval Hospital, Bethesda, MD 20814-5011.
Crit Care Med. 1989 May;17(5):423-5. doi: 10.1097/00003246-198905000-00009.
A retrospective review of all patients cared for who met Loe's criteria for extracorporeal membrane oxygenation (ECMO) was conducted covering the 3-yr period 1983 through 1985. There were five out of 3,726 admissions who met criteria for ECMO (three of 127 outborn admissions). All infants were greater than 2 kg birth weight and met criteria based on alveolar-arterial oxygen pressure difference (P[A-a]O2), barotrauma criteria, or both P(A-a)O2 and barotrauma criteria. All infants had persistent pulmonary hypertension. Two patients also had hyaline membrane disease and one also had asphyxia and meconium aspiration. All patients were treated with conventional therapy and all survived. There were no patients who met criteria for ECMO and died and there were no patients referred for ECMO during this period. Published criteria for ECMO estimate a control group mortality rate of 80% to 94%. Mortality for this series was 0%. (Ninety-five percent confidence interval for mortality in a group of five survivors is 0% to 45%.) Controlled trials of ECMO were not done initially because it was considered unethical. This series shows that historical mortality rates are no longer valid and that controlled trials must be done.
对1983年至1985年这3年期间所有符合洛氏体外膜肺氧合（ECMO）标准的接受治疗的患者进行了回顾性研究。在3726例入院患者中，有5例符合ECMO标准（127例院外出生的患者中有3例）。所有婴儿出生体重均超过2kg，且根据肺泡-动脉氧分压差（P[A-a]O2）、气压伤标准或P(A-a)O2和气压伤标准两者符合标准。所有婴儿均患有持续性肺动脉高压。2例患者还患有透明膜病，1例还患有窒息和胎粪吸入。所有患者均接受了常规治疗，且全部存活。在此期间，没有符合ECMO标准且死亡的患者，也没有转诊接受ECMO治疗的患者。已发表的ECMO标准估计对照组死亡率为80%至94%。该系列的死亡率为0%。（5名幸存者组死亡率的95%置信区间为0%至45%。）最初未进行ECMO对照试验，因为认为这不符合伦理。该系列表明，历史死亡率不再有效，必须进行对照试验。
