亚太地区儿童体外心肺复苏术：体外生命支持组织登记处的回顾性分析。
Extracorporeal Cardiopulmonary Resuscitation in Children of Asia Pacific: A Retrospective Analysis of Extracorporeal Life Support Organization Registry.
机构信息
Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
Department of Extracorporeal Circulation, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
出版信息
Chin Med J (Engl). 2018 Jun 20;131(12):1436-1443. doi: 10.4103/0366-6999.233946.
BACKGROUND
Recent advances in extracorporeal membrane oxygenation (ECMO) have led to increasing interest in its use during cardiopulmonary resuscitation (CPR). However, decisions regarding extracorporeal CPR (ECPR) in children are difficult as a result of limited studies, especially in Asia Pacific. The objective of this study was to investigate trends in survival and demographic details for children with ECPR in Asia Pacific recorded in the Extracorporeal Life Support Organization (ELSO) registry from 1999 to 2016 and identify the risk factors associated with in-hospital mortality.
METHODS
The data of children younger than 18 years of age who received ECPR over the past 18 years in Asia Pacific were retrospectively analyzed. The data were extracted from the ELSO registry and divided into two 9-year groups (Group 1: 1999-2007 and Group 2: 2008-2016) to assess temporal changes using univariate analysis. Then, univariate and multiple logistic regression analyses were performed between survivors and nonsurvivors to identify factors independently associated with in-hospital mortality.
RESULTS
A total of 321 children were included in final analysis, with an overall survival rate of 50.8%. Although survival rates were similar between Group 1 and Group 2 (43.1% vs. 52.5%, χ = 1.67, P = 0.196), the median age (1.7 [0.3, 19.2] months for Group 1 vs. 5.6 [0.8, 64.9] months for Group 2, t = -2.93, P = 0.003) and weight (3.7 [3.0, 11.5] kg for Group 1 vs. 6.0 [3.4, 20.3] kg for Group 2, t = -3.14, P = 0.002) of children increased over time, while the proportion of congenital heart disease (75.9% for Group 1 vs. 57.8% for Group 2, χ = 6.52, P = 0.011) and cardiogenic shock (36.2% for Group 1 vs. 7.2% for Group 2, χ = 36.59, P < 0.001) decreased. Patient conditions before ECMO were worse, while ECMO complications decreased across time periods, especially renal complications. Multiple logistic regression analysis of ECMO complications showed that disseminated intravascular coagulation (DIC), myocardial stunning, and neurological complications were independently associated with increased odds of hospital mortality.
CONCLUSIONS
The broader indications and decreased complication rates make EPCR to be applicated more and more extensive in children in Asia Pacific region. ECMO complications such as myocardial stunning are independently associated with decreased survival.
背景
体外膜肺氧合（ECMO）的最新进展导致人们对其在心肺复苏（CPR）期间的应用越来越感兴趣。然而，由于研究有限，尤其是在亚太地区，儿童体外心肺复苏（ECPR）的决策非常困难。本研究的目的是调查亚太地区在 1999 年至 2016 年期间在体外生命支持组织（ELSO）登记处记录的接受 ECPR 的儿童的生存趋势和人口统计学细节，并确定与院内死亡率相关的风险因素。
方法
回顾性分析了过去 18 年在亚太地区接受 ECPR 的年龄小于 18 岁的儿童数据。从 ELSO 登记处提取数据，并将其分为两个 9 年组（第 1 组：1999-2007 年；第 2 组：2008-2016 年），使用单因素分析评估时间变化。然后，对幸存者和非幸存者进行单因素和多因素逻辑回归分析，以确定与院内死亡率独立相关的因素。
结果
共纳入 321 例患儿进行最终分析，总体生存率为 50.8%。尽管第 1 组和第 2 组的生存率相似（43.1%比 52.5%，χ=1.67，P=0.196），但儿童的中位年龄（第 1 组 1.7[0.3，19.2]个月，第 2 组 5.6[0.8，64.9]个月，t=-2.93，P=0.003）和体重（第 1 组 3.7[3.0，11.5]kg，第 2 组 6.0[3.4，20.3]kg，t=-3.14，P=0.002）随时间推移而增加，而先天性心脏病的比例（第 1 组 75.9%，第 2 组 57.8%，χ=6.52，P=0.011）和心源性休克（第 1 组 36.2%，第 2 组 7.2%，χ=36.59，P<0.001）下降。ECMO 前患者病情恶化，而 ECMO 并发症随时间减少，尤其是肾脏并发症。对 ECMO 并发症的多因素逻辑回归分析表明，弥散性血管内凝血（DIC）、心肌顿抑和神经系统并发症与医院死亡率增加独立相关。
结论
亚太地区儿童的 ECPR 适应证越来越广泛，并发症发生率也越来越低。心肌顿抑等 ECMO 并发症与生存率降低独立相关。
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