From the Cardiac Intensive Care Unit, Nemours Children's Hospital, Orlando, Florida.
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
ASAIO J. 2019 May/Jun;65(4):367-370. doi: 10.1097/MAT.0000000000000825.
We investigated the safety and efficacy of surfactant during extracorporeal membrane oxygenation (ECMO) in children with cardiac disease. ECMO patients administered surfactant (surfactant group) were compared with patients who did not receive (control). Criteria to administer surfactant were based on a decreased lung compliance of <0.5 ml/kg/cm H2O. Efficacy was determined on pulmonary compliance change and the radiography-based respiratory distress severity (RDS) score. For the surfactant group, lung compliance measurements and RDS scores were obtained just before the first surfactant administration (T0), 24 hours after the last dose of surfactant (T1), and 24 hours after ECMO decannulation (T2). For the control group, measurements were obtained at baseline (T0), day of ECMO decannulation (T1), and 24 hours after ECMO decannulation (T2). Eighty were on ECMO, 29 in the surfactant, and 51 in the control group. Surfactant group was younger 20 (6-140) vs. 28 (8-928) days old (p = 0.03), had longer ECMO duration 110 (58-192) vs. 46 (29-84) hours (p = 0.001), and had longer mechanical ventilation 16 (11-26) vs. 7 (5-9) days (p = 0.003). The lung compliance and RDS scores in the surfactant group improved significantly between baseline and 24 hours after decannulation, 0.36 ± 0.13 vs. 0.5 ± 0.12 ml/kg/cm H2O (p = 0.002) and 13 ± 3 vs. 12 ± 2 (p = 0.04), respectively. None developed pneumothorax. Mild pulmonary hemorrhage occurred twice (one in each group). Hospital duration and survival were similar 36 (19-48) vs. 31 (18-48) days and 69% vs. 78% in surfactant and control groups, respectively. Although this is a relatively small study, surfactant appears to be safe in pediatric cardiac ECMO patients.
我们研究了在体外膜肺氧合（ECMO）期间使用表面活性剂对患有心脏病的儿童的安全性和疗效。接受表面活性剂治疗的 ECMO 患者（表面活性剂组）与未接受治疗的患者（对照组）进行了比较。给予表面活性剂的标准是肺顺应性降低至＜0.5ml/kg/cmH2O。通过肺顺应性的变化和基于 X 线的呼吸窘迫严重程度（RDS）评分来确定疗效。对于表面活性剂组，在第一次使用表面活性剂前（T0）、最后一次使用表面活性剂后 24 小时（T1）和 ECMO 拔管后 24 小时（T2）进行肺顺应性测量和 RDS 评分。对于对照组，在基线（T0）、ECMO 拔管日（T1）和 ECMO 拔管后 24 小时（T2）进行测量。80 例在 ECMO 上，29 例在表面活性剂组，51 例在对照组。表面活性剂组的年龄较小，为 20（6-140）岁 vs. 28（8-928）岁（p=0.03），ECMO 持续时间较长，为 110（58-192）小时 vs. 46（29-84）小时（p=0.001），机械通气时间较长，为 16（11-26）天 vs. 7（5-9）天（p=0.003）。表面活性剂组在拔管后 24 小时内肺顺应性和 RDS 评分显著改善，分别为 0.36±0.13ml/kg/cmH2O vs. 0.5±0.12ml/kg/cmH2O（p=0.002）和 13±3 vs. 12±2（p=0.04）。无一例发生气胸。两组均发生轻度肺出血各 2 例。表面活性剂组和对照组的住院时间和存活率相似，分别为 36（19-48）天和 31（18-48）天和 69%和 78%。尽管这是一项相对较小的研究，但表面活性剂似乎对儿科心脏 ECMO 患者是安全的。
