Elias Matthew D, Achuff Barbara-Jo, Ittenbach Richard F, Ravishankar Chitra, Spray Thomas L, Fuller Stephanie, Montenegro Lisa M, Gaynor J William, O'Connor Matthew J
1Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA. 2Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 3Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, OH. 4Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
Pediatr Crit Care Med. 2017 Aug;18(8):787-794. doi: 10.1097/PCC.0000000000001227.
Extracorporeal membrane oxygenation is an important form of short-term mechanical support in children with cardiac disease, but information on long-term outcomes and quality of life is limited. The primary objective of this study was to determine the long-term outcomes of children previously supported by extracorporeal membrane oxygenation for cardiac etiologies.
A retrospective analysis was performed on patients with cardiac disease managed with extracorporeal membrane oxygenation between January 1, 1995, and December 31, 2012, at the Children's Hospital of Philadelphia. Survivors completed patient- and parent-reported verbal and written surveys, and univariate analyses assessed risk factors for long-term outcomes.
Tertiary-care children's hospital.
Patients with cardiac disease managed with extracorporeal membrane oxygenation.
None.
Over 18 years, 396 patients were managed with extracorporeal membrane oxygenation with 43% survival to discharge. The median age at cannulation was 78 days. The majority had congenital heart disease (86%), surgery prior to extracorporeal membrane oxygenation (71%), and cardiopulmonary arrest as the primary extracorporeal membrane oxygenation indication (53%). With 6-year median follow-up, 66% are known to be deceased, including 38 deaths after hospital discharge. Among survivors at discharge, 65 (38%) completed the phone survey, and 33 (19%) completed the written survey. Negative clinical outcomes, defined as having at least significant physical limitations or "fair" or "poor" health, were present in 18% of patients. No patient- or extracorporeal membrane oxygenation-related variables were associated with negative outcomes in univariate analyses. There were significantly lower self-reported and parent-reported written Pediatric Quality of Life Inventory quality of life scores in children compared with healthy individual normative data but no differences in adolescents.
In this series of pediatric cardiac patients supported by extracorporeal membrane oxygenation, mortality was 66% with 6-year median follow-up. The majority reported positive outcomes with respect to health and physical limitations, but children reported lower quality of life compared with healthy individuals.
体外膜肺氧合是患有心脏病儿童短期机械支持的一种重要形式，但关于长期预后和生活质量的信息有限。本研究的主要目的是确定先前因心脏病因接受体外膜肺氧合支持的儿童的长期预后。
对1995年1月1日至2012年12月31日期间在费城儿童医院接受体外膜肺氧合治疗的心脏病患者进行回顾性分析。幸存者完成了患者和家长报告的口头和书面调查，单因素分析评估了长期预后的危险因素。
三级医疗儿童医院。
接受体外膜肺氧合治疗的心脏病患者。
无。
在18年期间，396例患者接受了体外膜肺氧合治疗，43%存活至出院。插管时的中位年龄为78天。大多数患者患有先天性心脏病（86%），在接受体外膜肺氧合治疗之前接受过手术（71%），以心肺骤停作为体外膜肺氧合的主要指征（53%）。中位随访6年时，已知66%的患者死亡，包括出院后38例死亡。出院时的幸存者中，65例（38%）完成了电话调查，33例（19%）完成了书面调查。18%的患者存在负面临床结局，定义为至少有明显的身体限制或“一般”或“差”的健康状况。在单因素分析中，没有患者或与体外膜肺氧合相关的变量与负面结局相关。与健康个体的标准数据相比，儿童自我报告和家长报告的书面儿童生活质量量表生活质量得分显著较低，但青少年没有差异。
在这一系列接受体外膜肺氧合支持的儿科心脏病患者中，中位随访6年时死亡率为66%。大多数患者在健康和身体限制方面报告了积极的结果，但与健康个体相比，儿童报告的生活质量较低。
