Lovvorn Harold N, Hardison Daphne C, Chen Heidi, Westrick Ashly C, Danko Melissa E, Bridges Brian C, Walsh William F, Pietsch John B
Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN.
Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN.
Surgery. 2017 Aug;162(2):385-396. doi: 10.1016/j.surg.2017.03.020. Epub 2017 May 24.
Extracorporeal membrane oxygenation is a resource-intensive mode of life-support potentially applicable when conventional therapies fail. Given the initial success of extracorporeal membrane oxygenation to support neonates and infants in the 1980s, indications have expanded to include adolescents, adults, and selected moribund patients during cardiopulmonary resuscitation. This single-institution analysis was conducted to evaluate programmatic growth, outcomes, and risk for death despite extracorporeal membrane oxygenation across all ages and diseases.
Beginning in 1989, we registered prospectively all extracorporeal membrane oxygenation patient data with the Extracorporeal Life Support Organization. We queried this registry for our institution-specific data to compare the parameter of "discharge alive" between age groups (neonatal, pediatric, adult), disease groups (respiratory, cardiac, cardiopulmonary resuscitation), and modes of extracorporeal membrane oxygenation (veno-venous; veno-arterial). Extracorporeal membrane oxygenation-specific complications (mechanical, hemorrhagic, neurologic, renal, cardiovascular, pulmonary, infectious, metabolic) were analyzed similarly. Descriptive statistics, Kaplan-Meier, and linear regression analyses were conducted.
After 1,052 extracorporeal membrane oxygenation runs, indications have expanded to include adults, to supplement cardiopulmonary resuscitation, to support hemodialysis in neonates and plasmapheresis in children, and to bridge all age patients to heart and lung transplant. Overall survival to discharge was 52% and was better for respiratory diseases (P < .001). Probability of individual survival decreased to <50% if pre-extracorporeal membrane oxygenation mechanical ventilation exceeded respectively 123 hours for cardiac, 166 hours for cardiopulmonary resuscitation, and 183 hours for respiratory diseases (P = .013). Complications occurred most commonly among cardiac and cardiopulmonary resuscitation runs (P < .001), the veno-arterial mode (P < .001), and in adults (P = .044).
Our extracorporeal membrane oxygenation program, an Extracorporeal Life Support Organization-designated Center of Excellence, has experienced substantial growth in volume and indications, including increasing age and disease severity. Considering the entire cohort, pre-extracorporeal membrane oxygenation ventilation exceeding 7 days was associated with an increased probability of death.
体外膜肺氧合是一种资源密集型的生命支持模式，在传统疗法失败时可能适用。鉴于20世纪80年代体外膜肺氧合在支持新生儿和婴儿方面取得了初步成功，其适应证已扩大到包括青少年、成年人以及心肺复苏期间选定的濒死患者。本单机构分析旨在评估所有年龄和疾病患者接受体外膜肺氧合治疗后的项目发展、结局和死亡风险。
从1989年开始，我们前瞻性地向体外生命支持组织登记了所有体外膜肺氧合患者的数据。我们查询该登记处获取我们机构的特定数据，以比较不同年龄组（新生儿、儿科、成人）、疾病组（呼吸、心脏、心肺复苏）和体外膜肺氧合模式（静脉 - 静脉；静脉 - 动脉）之间的“出院存活”参数。对体外膜肺氧合特有的并发症（机械性、出血性、神经性、肾性、心血管性、肺部、感染性、代谢性）进行了类似分析。进行了描述性统计、Kaplan - Meier分析和线性回归分析。
在1052次体外膜肺氧合治疗后，适应证已扩大到包括成人，用于补充心肺复苏，支持新生儿血液透析和儿童血浆置换，并作为所有年龄患者进行心肺移植的桥梁。总体出院生存率为52%，呼吸系统疾病患者的生存率更高（P <.001）。如果体外膜肺氧合前机械通气时间分别超过心脏疾病123小时、心肺复苏166小时和呼吸系统疾病183小时，个体存活概率降至<50%（P =.013）。并发症最常发生在心脏和心肺复苏治疗中（P <.001）、静脉 - 动脉模式（P <.001）以及成人患者中（P =.044）。
我们的体外膜肺氧合项目是体外生命支持组织指定的卓越中心，在治疗量和适应证方面有了显著增长，包括年龄增长和疾病严重程度增加。考虑整个队列，体外膜肺氧合前通气超过7天与死亡概率增加相关。
