von Bahr Viktor, Hultman Jan, Eksborg Staffan, Gerleman Roxana, Enstad Øyvind, Frenckner Björn, Kalzén Håkan
1Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden. 2ECMO Center Karolinska, ECMO Department, Karolinska University Hospital, Stockholm, Sweden. 3Childhood Cancer Research Unit Q6:05, Department of Women's and Children's Health, Karolinska Institutet and Astrid Lindgren Children's Hospital, Stockholm, Sweden. 4Department of Anesthesiology and Intensive Care, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark. 5Department of Women's and Children's Health, Pediatric Surgery, Karolinska Institutet and Astrid Lindgren Children's Hospital, Stockholm, Sweden.
Pediatr Crit Care Med. 2017 Mar;18(3):272-280. doi: 10.1097/PCC.0000000000001069.
Extracorporeal membrane oxygenation has been used in patients with severe circulatory or respiratory failure since the 1970s, but the knowledge on long-term survival in this group is scarce. The aim of the present study was to investigate the 10-year survival rates and causes of late death in children treated with extracorporeal membrane oxygenation.
Single-center, retrospective cohort study.
Tertiary referral center for extracorporeal life support.
Neonatal and pediatric patients treated with extracorporeal membrane oxygenation from 1987 to December 2013.
None.
Survival status was obtained from the national Causes of Death registry. Patient background data along with data on survival and causes of death were collected. Survival rates were calculated using the Kaplan-Meier method. Of 400 subjects, 76% survived to discharge. The median follow-up time in survivors was 7.2 years. There was a high mortality rate within the first months after discharge. In the group of patients who survived the first 90 days after treatment, the 10-year survival rates were 93% in neonates and 89% in pediatric patients and were particularly beneficial in patients whose indication for extracorporeal membrane oxygenation was meconium aspiration syndrome, trauma, or infectious diseases. Late deaths were seen in some diagnostic groups, but the Kaplan-Meier curves plateaued over time.
Children who survive the first months after treatment with extracorporeal membrane oxygenation have a high long-term survival rate. The prognosis is especially favorable in patients with reversible conditions.
自20世纪70年代以来，体外膜肺氧合已用于治疗严重循环或呼吸衰竭的患者，但关于该组患者长期生存情况的了解却很少。本研究的目的是调查接受体外膜肺氧合治疗的儿童的10年生存率及晚期死亡原因。
单中心回顾性队列研究。
体外生命支持三级转诊中心。
1987年至2013年12月接受体外膜肺氧合治疗的新生儿和儿科患者。
无。
生存状态来自国家死亡原因登记处。收集患者背景数据以及生存和死亡原因的数据。采用Kaplan-Meier法计算生存率。400名受试者中，76%存活至出院。存活者的中位随访时间为7.2年。出院后的头几个月内死亡率很高。在治疗后存活前90天的患者组中，新生儿的10年生存率为93%，儿科患者为89%，对于因胎粪吸入综合征、创伤或传染病而接受体外膜肺氧合治疗的患者尤其有益。在一些诊断组中出现了晚期死亡，但Kaplan-Meier曲线随时间趋于平稳。
接受体外膜肺氧合治疗后最初几个月存活的儿童长期生存率较高。对于病情可逆的患者，预后尤其良好。
