小儿开胸心肺复苏术后 1 年生存率和神经学结局。
One-Year Survival and Neurologic Outcomes After Pediatric Open-Chest Cardiopulmonary Resuscitation.
机构信息
Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan.
Department of Cardiothoracic Surgery, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan.
出版信息
Ann Thorac Surg. 2019 May;107(5):1441-1446. doi: 10.1016/j.athoracsur.2018.11.028. Epub 2018 Dec 14.
BACKGROUND
Limited data exist about neurobehavioral outcomes of children treated with open-chest cardiopulmonary resuscitation (CPR). Our objective was to describe neurobehavioral outcomes 1 year after arrest among children who received open-chest CPR during in-hospital cardiac arrest and to explore factors associated with 1-year survival and survival with good neurobehavioral outcome.
METHODS
The study is a secondary analysis of the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital Trial. Fifty-six children who received open-chest CPR for in-hospital cardiac arrest were included. Neurobehavioral status was assessed using the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) at baseline before arrest and 12 months after arrest. Norms for VABS-II are 100 ± 15 points. Outcomes included 12-month survival, 12-month survival with VABS-II decreased by no more than 15 points from baseline, and 12-month survival with VABS-II of 70 or more points.
RESULTS
Of 56 children receiving open-chest CPR, 49 (88%) were after cardiac surgery and 43 (77%) were younger than 1 year. Forty-four children (79%) were cannulated for extracorporeal membrane oxygenation (ECMO) during CPR or within 6 hours of return of spontaneous circulation. Thirty-three children (59%) survived to 12 months, 22 (41%) survived to 12 months with VABS-II decreased by no more than 15 points from baseline, and of the children with baseline VABS-II of 70 or more points 23 (51%) survived to 12 months with VABS-II of 70 or more points. On multivariable analyses, use of ECMO, renal replacement therapy, and higher maximum international normalized ratio were independently associated with lower 12-month survival with VABS-II of 70 or more points.
CONCLUSIONS
Approximately one-half of children survived with good neurobehavioral outcome 1 year after open-chest CPR for in-hospital cardiac arrest. Use of ECMO and postarrest renal or hepatic dysfunction may be associated with worse neurobehavioral outcomes.
背景
目前关于接受开胸心肺复苏术（CPR）治疗的儿童的神经行为学结局的数据有限。我们的目的是描述在院内心脏骤停期间接受开胸 CPR 的儿童在复苏后 1 年的神经行为学结局，并探讨与 1 年生存率和生存时具有良好神经行为学结局相关的因素。
方法
该研究是儿科心脏骤停院内治疗性低温试验的二次分析。共纳入 56 例因院内心脏骤停接受开胸 CPR 的患儿。在复苏前基线和复苏后 12 个月，使用第二版 Vineland 适应行为量表（VABS-II）评估神经行为状态。VABS-II 的正常值为 100±15 分。结局包括 12 个月生存率、12 个月生存率且 VABS-II 较基线下降不超过 15 分，以及 12 个月生存率且 VABS-II 为 70 分或更高。
结果
在接受开胸 CPR 的 56 例患儿中，49 例（88%）为心脏手术后患儿，43 例（77%）年龄小于 1 岁。44 例患儿（79%）在 CPR 期间或自主循环恢复后 6 小时内接受了体外膜氧合（ECMO）插管。33 例患儿（59%）存活至 12 个月，22 例（41%）存活至 12 个月且 VABS-II 较基线下降不超过 15 分，基线 VABS-II 为 70 分或更高的患儿中，有 23 例（51%）存活至 12 个月且 VABS-II 为 70 分或更高。多变量分析显示，使用 ECMO、肾脏替代治疗和更高的最大国际标准化比值与 12 个月生存率且 VABS-II 为 70 分或更高独立相关。
结论
大约一半的儿童在接受开胸心肺复苏术治疗院内心脏骤停后 1 年时具有良好的神经行为学结局。ECMO 的使用和复苏后肾脏或肝脏功能障碍可能与较差的神经行为学结局相关。
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