Asano Miki, Matsumae Hidekazu, Suzuki Kazutaka, Nakai Yousuke, Nakayama Takuya, Nomura Norikazu, Mishima Akira
Faculty of Health Promotional Sciences, Tokoha University, 1230 Miyakota, Kita-ku, Hamamatsu, 431-2102, Japan.
Department of Cardiovascular Surgery, Nagoya City University, Nagoya, Japan.
Pediatr Cardiol. 2019 Jan;40(1):89-100. doi: 10.1007/s00246-018-1964-y. Epub 2018 Aug 21.
We evaluated the morbidity and mortality of children requiring postcardiotomy extracorporeal membrane oxygenation (ECMO) to determine independent factors affecting early and intermediate outcomes. Between January 2002 and December 2015, 79 instances of ECMO after cardiac surgery in 73 children were retrospectively reviewed. Follow-up was completed in December 2016. Predictive risk analyses were employed concerning weaning of ECMO, hospital discharge, and mortality after discharge. Age and weight were 14.9 ± 25.6 months and 7.0 ± 5.3 kg, respectively. Median support time was 8.3 ± 4.4 days. Sixty-seven (85%) were successfully weaned off ECMO and 48 (61%) survived to hospital discharge. Multi-variate logistic regression analysis identified the first day to obtain negative fluid balance after initiation of support (adjusted odds ratio = 0.42), high serum lactate levels (0.97), and high total bilirubin (0.84) during support as significant independent factors associated with successful separation from ECMO. The first day of negative fluid balance (0.65) after successful decannulation was an independent risk factor for survival to hospital discharge. After hospital discharge, actuarial 1-year, 5-year, and 10-year survival rates were 94%, 78%, and 78%, respectively. Low weight increased the risk of death after hospital discharge by a multi-variate Cox hazard model. High serum lactate, high serum bilirubin, and unable to obtain early negative fluid balance during support impacted mortality of decannulation. Obtaining a late negative fluid balance in post-ECMO were independent risk factors for death after successful weaning. Low weight affected intermediate outcomes.
我们评估了需要体外膜肺氧合（ECMO）辅助的儿童心脏术后的发病率和死亡率，以确定影响早期和中期预后的独立因素。回顾性分析了2002年1月至2015年12月期间73例儿童心脏术后接受ECMO治疗的79次病例。随访至2016年12月结束。对ECMO撤机、出院及出院后死亡率进行了预测风险分析。年龄和体重分别为14.9±25.6个月和7.0±5.3千克。中位支持时间为8.3±4.4天。67例（85%）成功撤机，48例（61%）存活至出院。多因素逻辑回归分析显示，支持开始后第一天实现负液体平衡（校正比值比=0.42）、支持期间高血清乳酸水平（0.97）和高总胆红素水平（0.84）是与成功撤离ECMO相关的重要独立因素。成功拔管后第一天实现负液体平衡（0.65）是存活至出院的独立危险因素。出院后，1年、5年和10年的精算生存率分别为94%、78%和78%。多因素Cox风险模型显示，低体重增加了出院后死亡风险。支持期间高血清乳酸、高血清胆红素以及未能早期实现负液体平衡影响了拔管死亡率。ECMO后晚期实现负液体平衡是成功撤机后死亡的独立危险因素。低体重影响中期预后。
