Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
Surgical Outcomes Center for Kids (SOCKs), Department of Pediatric Surgery, Monroe Carell Jr Children's Hospital, Nashville, TN.
Pediatr Crit Care Med. 2020 May;21(5):469-476. doi: 10.1097/PCC.0000000000002269.
Examine the outcomes of pediatric burn patients requiring extracorporeal membrane oxygenation to determine whether extracorporeal membrane oxygenation should be considered in this special population.
Retrospective cohort study.
All extracorporeal membrane oxygenation centers reporting to the Extracorporeal Life Support Organization.
Pediatric patients (birth to younger than 18 yr) who were supported with extracorporeal membrane oxygenation with a burn diagnosis between 1990 and 2016.
None.
A total of 113 patients were identified from the registry by inclusion criteria. Patients cannulated for respiratory failure had the highest survival (55.7%, n = 97) compared to those supported for cardiac failure (33.3%, n = 6) or extracorporeal cardiopulmonary resuscitation (30%, n = 10). Patients supported on venovenous extracorporeal membrane oxygenation for respiratory failure had the best overall survival at 62.2% (n = 37). Important for the burn population, rates of surgical site bleeding were similar to other surgical patients placed on extracorporeal membrane oxygenation at 22.1%. Cardiac arrest prior to cannulation was associated with increased hospital mortality (odds ratio, 3.41; 95% CI, 0.16-1.01; p = 0.048). Following cannulation, complications including the need for inotropes (odds ratio, 2.64; 95% CI, 1.24-5.65; p = 0.011), presence of gastrointestinal hemorrhage (p = 0.049), and hyperglycemia (glucose > 240 mg/dL) (odds ratio, 3.42; 95% CI, 1.13-10.38; p = 0.024) were associated with increased mortality. Of patients with documented burn percentage of total body surface area (n = 19), survival was 70% when less than 60% total body surface area was involved.
Extracorporeal membrane oxygenation could be considered as an additional level of support for the pediatric burn population, especially in the setting of respiratory failure. Additional studies are necessary to determine the optimal timing of cannulation and other patient characteristics that may impact outcomes.
研究需要体外膜氧合（ECMO）支持的儿科烧伤患者的结局，以确定是否应考虑在该特殊人群中使用 ECMO。
回顾性队列研究。
向体外生命支持组织报告的所有 ECMO 中心。
1990 年至 2016 年间接受 ECMO 治疗且诊断为烧伤的出生至 17 岁以下的儿科患者。
无。
根据纳入标准，从登记处共确定了 113 例患者。因呼吸衰竭而插管的患者存活率最高（55.7%，n=97），其次是因心力衰竭（33.3%，n=6）或体外心肺复苏（30%，n=10）而接受支持的患者。因呼吸衰竭而接受静脉-静脉 ECMO 支持的患者总体生存率最佳，为 62.2%（n=37）。对于烧伤患者，手术部位出血率与其他接受 ECMO 治疗的手术患者相似，为 22.1%。插管前发生心脏骤停与住院死亡率增加相关（优势比，3.41；95%置信区间，0.16-1.01；p=0.048）。插管后，并发症包括需要使用正性肌力药物（优势比，2.64；95%置信区间，1.24-5.65；p=0.011）、存在胃肠道出血（p=0.049）和高血糖（血糖>240mg/dL）（优势比，3.42；95%置信区间，1.13-10.38；p=0.024）与死亡率增加相关。在有记录的烧伤患者总体表百分比（n=19）中，当总体表面积小于 60%时，生存率为 70%。
对于儿科烧伤人群，ECMO 可以作为一种额外的支持手段，特别是在出现呼吸衰竭的情况下。需要进一步研究以确定插管的最佳时机和可能影响结局的其他患者特征。
