Maue Danielle K, Hobson Michael J, Friedman Matthew L, Moser Elizabeth As, Rowan Courtney M
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Biostatistics, Indiana University, Indianapolis, IN, USA.
Perfusion. 2019 Oct;34(7):598-604. doi: 10.1177/0267659119842471. Epub 2019 Apr 24.
BACKGROUND/OBJECTIVES: There is controversy regarding the utilization of extracorporeal membrane oxygenation in pediatric patients with an underlying oncologic diagnosis or who have undergone hematopoietic cell transplant. We hypothesized that these patients have higher mortality, more bleeding complications, more blood product utilization, and a higher rate of new infections than the general pediatric intensive care unit population supported with extracorporeal membrane oxygenation.
DESIGN/METHODS: This is a retrospective chart review at a single center quaternary care pediatric hospital including all pediatric intensive care unit extracorporeal membrane oxygenation patients from 2011 to 2016. Patients were categorized as either oncology/hematopoietic cell transplant or general pediatric intensive care unit. Patients from the cardiovascular intensive care unit or the neonatal intensive care unit were excluded.
A total of 38 patients met inclusion criteria of which 7 were oncology/hematopoietic cell transplant patients. The oncology/hematopoietic cell transplant group had lower platelets at the start of extracorporeal membrane oxygenation (p = 0.02) but other pre-extracorporeal membrane oxygenation characteristics were similar. Extracorporeal membrane oxygenation survival was lower in the oncology/hematopoietic cell transplant group (29% vs 77%, p = 0.02). The incidence of bleeding complications and new infections did not differ. The oncology/hematopoietic cell transplant group received more platelets (median of 15.9 mL/kg/day (interquartile range 8.4, 36.6) vs 7.9 mL/kg/day (3.3, 21.9), p = 0.04) and fresh frozen plasma (14.0 mL/kg/day (3, 15.7) vs 1.8 mL/kg/day (0.5, 5.9), p = 0.04).
Oncology and hematopoietic cell transplant patients had a higher mortality and received more blood products while on extracorporeal membrane oxygenation than the general pediatric intensive care unit patients despite similar pre-extracorporeal membrane oxygenation characteristics. Physicians should use caution when deciding whether or not to utilize extracorporeal membrane oxygenation in this population.
背景/目的：对于患有潜在肿瘤诊断或接受过造血细胞移植的儿科患者使用体外膜肺氧合（ECMO）存在争议。我们假设，与接受ECMO支持的普通儿科重症监护病房患者相比，这些患者死亡率更高、出血并发症更多、血液制品使用量更大且新发感染率更高。
设计/方法：这是一项在一家单一中心的四级护理儿科医院进行的回顾性病历审查，纳入了2011年至2016年期间所有儿科重症监护病房接受ECMO治疗的患者。患者分为肿瘤/造血细胞移植组或普通儿科重症监护病房组。心血管重症监护病房或新生儿重症监护病房的患者被排除。
共有38例患者符合纳入标准，其中7例为肿瘤/造血细胞移植患者。肿瘤/造血细胞移植组在开始ECMO治疗时血小板水平较低（p = 0.02），但其他ECMO治疗前特征相似。肿瘤/造血细胞移植组的ECMO生存率较低（29%对77%，p = 0.02）。出血并发症和新发感染的发生率没有差异。肿瘤/造血细胞移植组接受了更多的血小板（中位数为15.9 mL/kg/天（四分位间距8.4，36.6）对7.9 mL/kg/天（3.3，21.9），p = 0.04）和新鲜冰冻血浆（14.0 mL/kg/天（3，15.7）对1.8 mL/kg/天（0.5，5.9），p = 0.04）。
尽管肿瘤和造血细胞移植患者在ECMO治疗前特征相似，但与普通儿科重症监护病房患者相比，他们在接受ECMO治疗时死亡率更高且接受了更多的血液制品。医生在决定是否对该人群使用ECMO时应谨慎。
