Cashen Katherine, Reeder Ron, Dalton Heidi J, Berg Robert A, Shanley Thomas P, Newth Christopher J L, Pollack Murray M, Wessel David, Carcillo Joseph, Harrison Rick, Dean J Michael, Jenkins Tammara, Meert Kathleen L
1Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan/Wayne State University, Detroit, MI. 2Department of Pediatrics, University of Utah, Salt Lake City, UT. 3Department of Child Health, Phoenix Children's Hospital, Phoenix, AZ. 4Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA. 5Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI. 6Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 7Department of Pediatrics, Children's National Medical Center, Washington, DC. 8Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 9Department of Pediatrics, Mattel Children's Hospital UCLA, Los Angeles, CA. 10Pediatric Trauma and Critical Illness Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Pediatr Crit Care Med. 2017 Jun;18(6):561-570. doi: 10.1097/PCC.0000000000001155.
To describe functional status at hospital discharge for neonatal and pediatric patients treated with extracorporeal membrane oxygenation, and identify factors associated with functional status and mortality.
Secondary analysis of observational data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014.
Eight hospitals affiliated with the Collaborative Pediatric Critical Care Research Network.
Patients were less than 19 years old and treated with extracorporeal membrane oxygenation.
Functional status was evaluated among survivors using the Functional Status Scale. Total Functional Status Scale scores range from 6 to 30 and are categorized as 6-7 (good), 8-9 (mildly abnormal), 10-15 (moderately abnormal), 16-21 (severely abnormal), and greater than 21 (very severely abnormal).
Of 514 patients, 267 (52%) were neonates (≤ 30 d old). Indication for extracorporeal membrane oxygenation was respiratory for 237 (46%), cardiac for 207 (40%), and extracorporeal cardiopulmonary resuscitation for 70 (14%). Among 282 survivors, 89 (32%) had good, 112 (40%) mildly abnormal, 67 (24%) moderately abnormal, and 14 (5%) severely or very severely abnormal function at hospital discharge. Among neonates, development of renal failure and longer hospitalization were independently associated with worse Functional Status Scale. Chronic conditions, prematurity, venoarterial extracorporeal membrane oxygenation, increased red cell transfusion in the first 24 hours of extracorporeal membrane oxygenation, and longer extracorporeal membrane oxygenation duration were independently associated with mortality. Among pediatric patients, chronic neurologic conditions, tracheostomy or home ventilator, extracorporeal cardiopulmonary resuscitation, hepatic dysfunction, and longer ICU stay were independently associated with worse Functional Status Scale. Chronic cardiac conditions, hepatic dysfunction, and neurologic or thrombotic complications were independently associated with mortality. Achieving blood lactate concentration less than or equal to 2 mmol/L during extracorporeal membrane oxygenation was independently associated with survival in both neonatal and pediatric patients.
In this study, about half of extracorporeal membrane oxygenation patients survived with good, mildly abnormal, or moderately abnormal function at hospital discharge. Patient and extracorporeal membrane oxygenation-related factors are associated with functional status and mortality.
描述接受体外膜肺氧合治疗的新生儿和儿科患者出院时的功能状态，并确定与功能状态和死亡率相关的因素。
对协作儿科重症监护研究网络在2012年12月至2014年9月期间收集的观察数据进行二次分析。
协作儿科重症监护研究网络下属的八家医院。
年龄小于19岁且接受体外膜肺氧合治疗的患者。
使用功能状态量表对幸存者的功能状态进行评估。功能状态量表总分范围为6至30分，分为6 - 7分（良好）、8 - 9分（轻度异常）、10 - 15分（中度异常）、16 - 21分（重度异常）和大于21分（极重度异常）。
514例患者中，267例（52%）为新生儿（≤30日龄）。体外膜肺氧合的指征为呼吸问题的有237例（46%），心脏问题的有207例（40%），体外心肺复苏的有70例（14%）。在282例幸存者中，89例（32%）出院时功能良好，112例（40%）轻度异常，67例（24%）中度异常，14例（5%）重度或极重度异常。在新生儿中，肾衰竭的发生和住院时间延长与功能状态量表评分较差独立相关。慢性病、早产、静脉 - 动脉体外膜肺氧合、体外膜肺氧合开始后24小时内红细胞输注增加以及体外膜肺氧合持续时间延长与死亡率独立相关。在儿科患者中，慢性神经疾病、气管切开或家庭通气、体外心肺复苏、肝功能障碍以及ICU住院时间延长与功能状态量表评分较差独立相关。慢性心脏疾病、肝功能障碍以及神经或血栓并发症与死亡率独立相关。体外膜肺氧合期间血乳酸浓度≤2 mmol/L与新生儿和儿科患者的存活独立相关。
在本研究中，约一半接受体外膜肺氧合治疗的患者出院时功能良好、轻度异常或中度异常且存活。患者及与体外膜肺氧合相关的因素与功能状态和死亡率相关。
