Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Pediatric Surgery, Texas Children's Hospital, Houston, Texas.
J Surg Res. 2021 Jan;257:260-266. doi: 10.1016/j.jss.2020.07.036. Epub 2020 Aug 27.
Indications for extracorporeal life support (ECLS) have evolved and expanded, yet its use in trisomy 13 (T13) and trisomy 18 (T18) patients remains controversial. We reviewed the experience of the Extracorporeal Life Support Organization with ECLS in these patients to inform practice at our institution.
The Extracorporeal Life Support Organization registry was queried for all patients younger than 18 y with an International Classification of Diseases, Ninth Edition/Tenth Edition code for T13 or T18 from 2000 to 2018. Basic demographics, ECLS details, and clinical outcomes were recorded. Descriptive statistics were performed.
Twenty-eight patients were identified (15 with T13; 13 with T18), representing 0.06% (28 of 46,901) of pediatric ECLS cannulations. The median weight was 3.5 kg (range, 1.4-13), and age at cannulation was 52 d (range, 0 d-6.8 y). Time on ECLS ranged from 13 to 478 h (median, 114). Cardiac defects were diagnosed in 19 (68%) patients, of which 13 (46%) underwent surgical repair. Median oxygenation index pre-ECLS was 45. Venoarterial cannulations accounted for 82% of patients, whereas 14% underwent venovenous cannulation. Overall survival to hospital discharge was 46% with 86% of patients experiencing one or more complications. There were no survivors when cannulation continued past 12 d.
Although complications are frequent, the mortality rate in patients with T13 and T18 remains within the reported range for the general pediatric population. T13 and T18 alone should not be viewed as absolute contraindications to ECLS within the pediatric population but rather considered during the evaluation of a patient's potential candidacy.
体外生命支持（ECLS）的适应证已经发展和扩大，但在三体 13（T13）和三体 18（T18）患者中的应用仍存在争议。我们回顾了体外生命支持组织在这些患者中使用 ECLS 的经验，以指导我们机构的实践。
从 2000 年到 2018 年，从体外生命支持组织登记处查询了所有年龄小于 18 岁、国际疾病分类第 9 版/第 10 版编码为 T13 或 T18 的患者。记录了基本人口统计学、ECLS 细节和临床结果。进行了描述性统计。
共确定了 28 例患者（15 例 T13；13 例 T18），占儿科 ECLS 插管的 0.06%（28/46901）。中位体重为 3.5kg（范围，1.4-13），插管时年龄为 52 天（范围，0 天-6.8 岁）。ECLS 时间从 13 小时到 478 小时（中位数，114 小时）不等。19 例（68%）患者诊断出心脏缺陷，其中 13 例（46%）接受了手术修复。ECLS 前的氧合指数中位数为 45。动静脉插管占 82%的患者，而 14%的患者行静脉-静脉插管。出院时总体生存率为 46%，86%的患者发生了 1 种或多种并发症。当插管时间超过 12 天时，没有幸存者。
尽管并发症频繁，但 T13 和 T18 患者的死亡率仍在儿科人群的一般报道范围内。T13 和 T18 本身不应被视为儿科人群中 ECLS 的绝对禁忌证，而应在评估患者的潜在候选资格时加以考虑。
