Cardiovascular Center, National Taiwan University Hospital Yunlin Branch, Douliu City, Yunlin County, Taiwan; Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
J Formos Med Assoc. 2019 Sep;118(9):1339-1346. doi: 10.1016/j.jfma.2018.12.008. Epub 2019 Jan 4.
Extracorporeal membrane oxygenation (ECMO) provides short-term cardiopulmonary support for patients with acute cardiac and respiratory failure. This study reported the survival rate for pediatric patients from Taiwan's national cohort.
Patients under the age of 18 who received ECMO from January 1, 2002 to December 31, 2012 were identified from the Taiwan National Health Insurance Research Database. The underlying etiology for ECMO use was categorized into post-operative (n = 410), cardiac (245), pulmonary (146) groups, and others (120). A Cox regression model was used to determine hazard ratios and to compare 30-day and 1-year survival rates using post-operative group as a reference.
The average age of all 921 patients was 4.83 ± 5.84 years, and 59.1% were male. The overall mortality rate was 29.2% at 1 month, and 46.9% at 1 year. The cardiac origin group, consisting mostly of congenital heart disease without surgical intervention, myocarditis, and heart failure had a better outcome with an adjusted hazard ratio of 0.69 (95% CI 0.49-0.96, p = 0.008) at 30 days and 0.50 (95% CI 0.38-0.66, p < 0.001) at 1 year, as compared to the post-operative group.
In contrast to the widespread use of ECMO in respiratory distress syndrome in western countries, pediatric ECMO in Taiwan was more often applied to patients with underlying cardiovascular diseases. Mortality rates varied according to age groups and various etiologies. The results of this large pediatric cohort provides a different prospective in critical care outcomes in medical environments where ECMO is more widely available.
体外膜肺氧合（ECMO）为急性心、肺功能衰竭的患者提供短期心肺支持。本研究报告了来自台湾国家队列的儿科患者的生存率。
从台湾全民健康保险研究数据库中确定了 2002 年 1 月 1 日至 2012 年 12 月 31 日期间接受 ECMO 的年龄在 18 岁以下的患者。ECMO 使用的潜在病因分为术后（n=410）、心脏（245）、肺部（146）和其他（120）组。采用 Cox 回归模型确定危险比，并将术后组作为参考比较 30 天和 1 年的生存率。
921 例患者的平均年龄为 4.83±5.84 岁，其中 59.1%为男性。所有患者在 1 个月时的死亡率为 29.2%，在 1 年时为 46.9%。心脏起源组主要由未经手术干预的先天性心脏病、心肌炎和心力衰竭组成，调整后的危险比为 0.69（95%CI 0.49-0.96，p=0.008）在 30 天和 0.50（95%CI 0.38-0.66，p<0.001）在 1 年时，与术后组相比。
与西方国家广泛应用 ECMO 治疗呼吸窘迫综合征不同，台湾儿科 ECMO 更多地应用于心血管疾病基础患者。死亡率根据年龄组和各种病因而有所不同。本大规模儿科队列的研究结果为 ECMO 更广泛应用的医疗环境中的重症监护结局提供了不同的前景。
