Department of Pediatrics, Division of Pediatric Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Department of Pediatrics, Division of Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Pediatr Crit Care Med. 2020 Nov;21(11):949-958. doi: 10.1097/PCC.0000000000002468.
To evaluate the risk factors for mortality in pediatric extracorporeal membrane oxygenation patients.
Retrospective, single-center study.
PICU and Pediatric cardiothoracic ICU in an urban, quaternary care center.
All neonatal and pediatric patients requiring extracorporeal membrane oxygenation at our institution between January 2014 and December 2018, who underwent a standardized continuous electroencephalogram neuromonitoring protocol during most of the duration of extracorporeal membrane oxygenation support. We excluded patients who had extracorporeal membrane oxygenation initiated at another institution.
None.
Sixty-six children required extracorporeal membrane oxygenation support during this period. Four patients were excluded, three due to lack of electroencephalogram data, one with extracorporeal membrane oxygenation initiated at other institution. In the remaining 62, 11 patients (17%) had seizures, of which 5 (45%) had status epilepticus. Eight of 11 patients (72%) had exclusively electrographic seizures. A total of 33 patients (53.2%) died, of which 22 died during extracorporeal membrane oxygenation course, and one died 3 years after hospital discharge. Mean survival from extracorporeal membrane oxygenation initiation was 766.9 days (standard deviation, 691.7; median, 546.5; interquartile range 1-3, 97.7-1255.0). In multivariate analysis, increased risk of mortality was associated with the use of extracorporeal cardiopulmonary resuscitation (hazard ratio, 4.33; 95% CI, 1.75-10.72; p = 0.002), imaging findings of cerebral edema (hazard ratio, 14.31; 95% CI, 5.18-39.54; p < 0.001), high lactate level (> 100 mg/dL within 2 hr preextracorporeal membrane oxygenation) (hazard ratio, 1.22; 95% CI, 1.03-1.44; p = 0.022), and prolonged deep hypothermic circulatory arrest (hazard ratio, 3.43; 95% CI, 1.65-7.13; p < 0.001). Presence of seizures was associated with imaging findings of cerebral edema (hazard ratio, 4.16; 95% CI, 1.04-16.58; p = 0.04).
Seizures are common in children requiring extracorporeal membrane oxygenation support, with a high rate of electrographic seizures and status epilepticus, as in prior studies. Presence of cerebral edema is both risk factor for mortality and seizures. Other risk factors for mortality include extracorporeal cardiopulmonary resuscitation, high lactate levels, and prolonged deep hypothermic circulatory arrest.
评估儿科体外膜氧合患者死亡的危险因素。
回顾性、单中心研究。
城市四级医疗中心的儿科重症监护病房和儿科心胸重症监护病房。
2014 年 1 月至 2018 年 12 月期间，我院所有需要体外膜氧合的新生儿和儿科患者，在体外膜氧合支持期间大部分时间都接受了标准化的连续脑电图神经监测方案。我们排除了在其他机构开始体外膜氧合的患者。
无。
在此期间，有 66 名儿童需要体外膜氧合支持。有 4 名患者被排除在外，其中 3 名患者因缺乏脑电图数据，1 名患者因在其他机构开始体外膜氧合。在其余 62 名患者中，有 11 名（17%）患者出现癫痫发作，其中 5 名（45%）患者出现癫痫持续状态。11 名患者中有 8 名（72%）仅出现脑电图癫痫发作。共有 33 名患者（53.2%）死亡，其中 22 名在体外膜氧合过程中死亡，1 名在出院后 3 年死亡。从体外膜氧合开始的平均存活时间为 766.9 天（标准差为 691.7；中位数为 546.5；四分位距 1-3，97.7-1255.0）。多变量分析显示，体外心肺复苏的使用（危险比，4.33；95%置信区间，1.75-10.72；p=0.002）、脑水肿的影像学表现（危险比，14.31；95%置信区间，5.18-39.54；p<0.001）、高乳酸水平（体外膜氧合前 2 小时内>100mg/dL）（危险比，1.22；95%置信区间，1.03-1.44；p=0.022）和长时间深低温循环停止（危险比，3.43；95%置信区间，1.65-7.13；p<0.001）与死亡率增加相关。癫痫发作与脑水肿的影像学表现有关（危险比，4.16；95%置信区间，1.04-16.58；p=0.04）。
在需要体外膜氧合支持的儿童中，癫痫发作很常见，与既往研究一样，有很高的脑电图癫痫发作和癫痫持续状态发生率。脑水肿既是死亡的危险因素，也是癫痫发作的危险因素。其他死亡危险因素包括体外心肺复苏、高乳酸水平和长时间深低温循环停止。
