Delaplain Patrick T, Jancelewicz Tim, Di Nardo Matteo, Zhang Lishi, Yu Peter T, Cleary John P, Morini Francesco, Harting Matthew T, Nguyen Danh V, Guner Yigit S
Children's Hospital Los Angeles, Department of Pediatric Surgery, Los Angeles, CA; University of California Irvine Medical Center, Department of Surgery, Orange, CA.
Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Division of Pediatric Surgery, Memphis, TN.
J Pediatr Surg. 2019 May;54(5):903-908. doi: 10.1016/j.jpedsurg.2019.01.019. Epub 2019 Jan 31.
The purpose of this study was to identify management preferences that may exist in the care of infants with CDH receiving ECMO with emphasis on VV-ECMO.
A survey was created to measure treatment preferences regarding ECMO use in CDH. The survey was distributed to all APSA and ELSO/Euro-ELSO members via e-mail. Survey results were summarized using descriptive statistics.
The survey had 230 respondents. The survey participants were surgeons (75%), neonatologists/intensivists (23%), and "other" (2%). The mean annual center volume was 11.6(±9.6) CDH cases, and the average number treated with ECMO was 4.5 (±6.4) cases/yr. The most agreed upon criteria for ECMO initiation were preductal O saturation <80% refractory to ventilator manipulation and medical therapy (89%), oxygenation index >40 (80%), severe air-leak (79%), and mixed acidosis (75%). Over 60% of respondents agreed the VV-ECMO would be optimum for average risk neonates. However, this preference diminished as the pre-ECMO level of cardiac support increased. When asked about why each respondent would choose VA-ECMO over VV-ECMO, the responses varied significantly between surgeons and non-surgeons.
While there seem to be areas of consensus among practitioners, such as criteria for initiation of ECMO, this survey revealed substantial variation in individual practice patterns regarding the use of ECMO for CDH.
Qualitative, Survey.
IV.
本研究旨在确定在接受体外膜肺氧合（ECMO）治疗的先天性膈疝（CDH）婴儿护理中可能存在的管理偏好，重点是静脉-静脉ECMO（VV-ECMO）。
创建了一项调查，以衡量关于在CDH中使用ECMO的治疗偏好。该调查通过电子邮件分发给所有美国小儿外科学会（APSA）和体外生命支持组织（ELSO）/欧洲体外生命支持组织（Euro-ELSO）成员。使用描述性统计对调查结果进行总结。
该调查有230名受访者。调查参与者包括外科医生（75%）、新生儿科医生/重症监护医生（23%）和“其他”（2%）。中心每年平均处理11.6（±9.6）例CDH病例，平均每年接受ECMO治疗的病例数为4.5（±6.4）例。关于开始ECMO最一致认可的标准是经导管前血氧饱和度<80%，对呼吸机操作和药物治疗无效（89%）、氧合指数>40（80%）、严重气漏（79%）和混合性酸中毒（75%）。超过60%的受访者认为VV-ECMO对平均风险的新生儿是最佳选择。然而，随着ECMO前心脏支持水平的提高，这种偏好有所降低。当被问及为什么每个受访者会选择静脉-动脉ECMO（VA-ECMO）而不是VV-ECMO时，外科医生和非外科医生的回答差异很大。
虽然从业者之间似乎存在一些共识领域，如开始ECMO的标准，但这项调查显示，在使用ECMO治疗CDH方面，个体实践模式存在很大差异。
定性调查。
四级。
