d'Aranda Erwan, Pastene Bruno, Ughetto Fabrice, Cotte Jean, Esnault Pierre, Fouilloux Virginie, Mazzeo Cécilia, Mancini Julien, Lebel Stéphane, Paut Olivier
1Department of Pediatric Anesthesia and Intensive Care, La Timone University Children's Hospital, Marseille, France.2Intensive Care Unit, Sainte Anne Military Hospital, Toulon, France.3Department of Pediatric Cardiovascular Surgery, La Timone University Hospital, Marseille, France.4Public Health and Medical Informatics, La Timone University Hospital, Marseille, France.
Pediatr Crit Care Med. 2016 Oct;17(10):992-997. doi: 10.1097/PCC.0000000000000897.
To compare characteristics and outcome in children undergoing extracorporeal life support initiated in an extracorporeal life support center or at the patient's bedside in a local hospital, by means of a mobile cardiorespiratory assistance unit.
A retrospective study in a single PICU during 6 years. Extracorporeal life support was started either in our center (control group) or in the local hospital (mobile cardiorespiratory assistance unit group). The data collected were demographics, markers of patient's preextracorporeal life support condition, and outcome.
One hundred twenty-six children underwent extracorporeal life support, 105 in the control group and 21 in the mobile cardiorespiratory assistance unit group. There was no difference between groups in terms of age, weight, or Pediatric Risk of Mortality II score. There was a significant difference in organ failure etiology between groups, with more respiratory cases in the mobile cardiorespiratory assistance unit group (76.2%) and more cardiac surgery cases in the control group (60%; p < 0.001). The duration of extracorporeal life support was longer in the mobile cardiorespiratory assistance unit group than in the control group (10 [1-36] vs 5 [0-33] d; p = 0.003). PICU length of stay and mortality (60% vs 47.6%; p = 0.294) were not significantly different between the two groups. To allow comparison of a more homogenous population, a subgroup analysis was performed including only respiratory failure patients from the two groups (R-control group [n = 22] and R-mobile cardiorespiratory assistance unit group [n = 16]). PICU length of stay was 17 (3-64) days in the R-control group and 23 (1-45) days in the R-mobile cardiorespiratory assistance unit group (p = 0.564), and PICU mortality rate was 54.5% in the R-control group and 43.8% in the R-mobile cardiorespiratory assistance unit group (p = 0.511). There was no difference between the R-groups for age, weight, Pediatric Risk of Mortality II score, and markers of kidney or liver dysfunction, and lactate blood levels.
Extracorporeal life support can be safely initiated at children's bedside in the local hospital and then transported to the specialized referral center. Our results support the validity of an interregional organization of mobile cardiorespiratory assistance unit teams.
通过移动心肺辅助设备，比较在体外生命支持中心或当地医院患者床边开始接受体外生命支持的儿童的特征和治疗结果。
对一家重症监护病房6年间进行的一项回顾性研究。体外生命支持在我们中心（对照组）或当地医院（移动心肺辅助设备组）开始。收集的数据包括人口统计学资料、患者体外生命支持前状况的指标以及治疗结果。
126名儿童接受了体外生命支持，对照组105名，移动心肺辅助设备组21名。两组在年龄、体重或儿童死亡风险II评分方面无差异。两组间器官衰竭病因存在显著差异，移动心肺辅助设备组呼吸病例更多（76.2%），对照组心脏手术病例更多（60%；p<0.001）。移动心肺辅助设备组体外生命支持持续时间长于对照组（10[1-36]天对5[0-33]天；p=0.003）。两组间重症监护病房住院时间和死亡率（60%对47.6%；p=0.294）无显著差异。为了比较更同质的人群，进行了亚组分析，仅包括两组中的呼吸衰竭患者（R-对照组[n=22]和R-移动心肺辅助设备组[n=16]）。R-对照组重症监护病房住院时间为17（3-64）天，R-移动心肺辅助设备组为23（1-45）天（p=0.564），R-对照组重症监护病房死亡率为54.5%，R-移动心肺辅助设备组为43.8%（p=0.511）。R组在年龄、体重、儿童死亡风险II评分、肾脏或肝脏功能障碍指标以及血乳酸水平方面无差异。
体外生命支持可在当地医院儿童床边安全启动，然后转运至专业转诊中心。我们的结果支持了移动心肺辅助设备团队跨区域组织的有效性。
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