Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia & Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Department of Surgery, The Cardiac Center, The Children's Hospital of Philadelphia & Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Pediatr Crit Care Med. 2018 Jun;19(6):544-552. doi: 10.1097/PCC.0000000000001571.
Cardiopulmonary failure in children with cardiac disease differs from the general pediatric critical care population, yet the epidemiology of extracorporeal membrane oxygenation support in cardiac ICUs has not been described. We aimed to characterize extracorporeal membrane oxygenation utilization and outcomes across surgical and medical patients in pediatric cardiac ICUs.
Retrospective analysis of the Pediatric Cardiac Critical Care Consortium registry to describe extracorporeal membrane oxygenation frequency and outcomes. Within strata of medical and surgical hospitalizations, we identified risk factors associated with extracorporeal membrane oxygenation use through multivariate logistic regression.
Tertiary-care children's hospitals.
Neonates through adults with cardiac disease.
None.
There were 14,526 eligible hospitalizations from August 1, 2014, to June 30, 2016; 449 (3.1%) included at least one extracorporeal membrane oxygenation run. Extracorporeal membrane oxygenation was used in 329 surgical (3.5%) and 120 medical (2.4%) hospitalizations. Systemic circulatory failure and extracorporeal cardiopulmonary resuscitation were the most common extracorporeal membrane oxygenation indications. In the surgical group, risk factors associated with postoperative extracorporeal membrane oxygenation use included younger age, extracardiac anomalies, preoperative comorbidity, higher Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery category, bypass time, postoperative mechanical ventilation, and arrhythmias (all p < 0.05). Bleeding requiring reoperation (25%) was the most common extracorporeal membrane oxygenation complication in the surgical group. In the medical group, risk factors associated with extracorporeal membrane oxygenation use included acute heart failure and higher Vasoactive Inotropic Score at cardiac ICU admission (both p < 0.0001). Stroke (15%) and renal failure (15%) were the most common extracorporeal membrane oxygenation complications in the medical group. Hospital mortality was 49% in the surgical group and 63% in the medical group; mortality rates for hospitalizations including extracorporeal cardiopulmonary resuscitation were 50% and 83%, respectively.
This is the first multicenter study describing extracorporeal membrane oxygenation use and outcomes specific to the cardiac ICU and inclusive of surgical and medical cardiac disease. Mortality remains high, highlighting the importance of identifying levers to improve care. These data provide benchmarks for hospitals to assess their outcomes in extracorporeal membrane oxygenation patients and identify unique high-risk subgroups to target for quality initiatives.
儿童心脏病患者心肺衰竭与一般儿科重症监护人群不同，但心脏 ICU 体外膜氧合支持的流行病学尚未描述。我们旨在描述心脏 ICU 中外科和内科患者使用体外膜氧合的情况和结果。
对儿科心脏危重病联盟登记处进行回顾性分析，以描述体外膜氧合的频率和结果。在外科和内科住院治疗的分层中，我们通过多变量逻辑回归确定了与体外膜氧合使用相关的危险因素。
三级儿童医院。
患有心脏病的新生儿至成人。
无。
2014 年 8 月 1 日至 2016 年 6 月 30 日期间，有 14526 例符合条件的住院治疗，其中 449 例（3.1%）至少进行了一次体外膜氧合运行。体外膜氧合在 329 例外科（3.5%）和 120 例内科（2.4%）住院治疗中使用。全身循环衰竭和体外心肺复苏是体外膜氧合最常见的适应证。在外科组中，与术后体外膜氧合使用相关的危险因素包括年龄较小、心脏外异常、术前合并症、更高的胸外科医生-欧洲心脏病学会心脏手术风险分类、体外循环时间、术后机械通气和心律失常（均 p < 0.05）。需要再次手术的出血（25%）是外科组中体外膜氧合最常见的并发症。在内科组中，与体外膜氧合使用相关的危险因素包括急性心力衰竭和心脏 ICU 入院时更高的血管活性正性肌力评分（均 p < 0.0001）。中风（15%）和肾衰竭（15%）是内科组中体外膜氧合最常见的并发症。外科组的住院死亡率为 49%，内科组为 63%；包括体外心肺复苏的住院死亡率分别为 50%和 83%。
这是第一项描述心脏 ICU 特定于体外膜氧合使用和结果的多中心研究，包括外科和内科心脏疾病。死亡率仍然很高，这突出表明需要确定改善护理的杠杆。这些数据为医院提供了评估体外膜氧合患者治疗结果的基准，并确定了独特的高风险亚组，以便针对质量举措进行目标定位。
