Minnesota Poison Control System, Minneapolis, MN.
Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN.
Crit Care Med. 2020 Aug;48(8):1111-1119. doi: 10.1097/CCM.0000000000004401.
To assess trends in the use of extracorporeal membrane oxygenation for poisoning in the United States.
Retrospective cohort study.
The National Poison Data System, the databased owned and managed by the American Association of Poison Control Centers, the organization that supports and accredits all 55 U.S. Poison Centers, 2000-2018.
All patients reported to National Poison Data System treated with extracorporeal membrane oxygenation.
None.
In total, 407 patients met final inclusion criteria (332 adults, 75 children). Median age was 27 years (interquartile range, 15-39 yr); 52.5% were male. Median number of ingested substances was three (interquartile range, 2-4); 51.5% were single-substance exposures. Extracorporeal membrane oxygenation use in poisoned patients in the United States has significantly increased over time (z = 3.18; p = 0.001) in both adults (age > 12 yr) and children (age ≤ 12 yr), increasing by 9-100% per year since 2008. Increase in use occurred more commonly in adults. We found substantial geographical variation in extracorporeal membrane oxygenation use by geospatially mapping the ZIP code associated with the initial call, with large, primarily rural areas of the United States reporting no cases. Overall survival was 70% and did not vary significantly over the study period for children or adults. Patients with metabolic and hematologic poisonings were less likely to survive following extracorporeal membrane oxygenation than those with other poisonings (49% vs 72%; p = 0.004).
The use of extracorporeal membrane oxygenation to support critically ill, poisoned patients in the United States is increasing, driven primarily by increased use in patients greater than 12 years old. We observed no trends in survival over time. Mortality was higher when extracorporeal membrane oxygenation was used for metabolic or hematologic poisonings. Large, predominantly rural regions of the United States reported no cases of extracorporeal membrane oxygenation for poisoning. Further research should focus on refining criteria for the use of extracorporeal membrane oxygenation in poisoning.
评估美国使用体外膜肺氧合治疗中毒的趋势。
回顾性队列研究。
国家毒物数据系统，该系统由美国中毒控制中心协会拥有和管理，该协会支持和认证全美 55 个毒物中心，时间为 2000 年至 2018 年。
所有向国家毒物数据系统报告并接受体外膜肺氧合治疗的中毒患者。
无。
共有 407 名患者符合最终纳入标准（332 名成人，75 名儿童）。中位年龄为 27 岁（四分位距，15-39 岁）；52.5%为男性。中位摄入物质数为 3 种（四分位距，2-4 种）；51.5%为单一物质暴露。自 2008 年以来，美国中毒患者使用体外膜肺氧合的比例显著增加（z = 3.18；p = 0.001），无论是成人（年龄＞12 岁）还是儿童（年龄≤12 岁），每年增加 9-100%。这种增加在成人中更为常见。通过对初始呼叫相关的邮政编码进行地理空间映射，我们发现体外膜肺氧合的使用存在显著的地域差异，美国的大片主要是农村地区没有报告病例。儿童和成人的总体生存率在研究期间没有显著变化，为 70%。与其他中毒患者相比，代谢和血液中毒患者接受体外膜肺氧合后存活的可能性较小（49%比 72%；p = 0.004）。
美国使用体外膜肺氧合支持重症中毒患者的比例正在增加，主要是由于 12 岁以上患者使用量的增加。我们没有观察到随时间推移生存率的变化趋势。当使用体外膜肺氧合治疗代谢或血液中毒时，死亡率更高。美国的大片主要是农村地区没有报告体外膜肺氧合治疗中毒的病例。进一步的研究应集中于完善体外膜肺氧合在中毒治疗中的应用标准。
