Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
Crit Care Med. 2021 Apr 1;49(4):e381-e393. doi: 10.1097/CCM.0000000000004850.
The objective of this study was to provide an updated review of survival for pediatric hematopoietic stem cell transplantation patients requiring extracorporeal membrane oxygenation therapy as well as characterize the demographics, clinical variables, and complications associated with mortality.
Retrospective database review of the Extracorporeal Life Support Organization Registry from 1990 to 2019.
Extracorporeal membrane oxygenation centers reporting to Extracorporeal Life Support Organization.
Patients treated with extracorporeal membrane oxygenation greater than 28 days to 18 years old with International Classification of Diseases Ninth Revision, International Classification of Diseases Tenth Revision, and current procedural terminology codes consistent with hematopoietic stem cell transplantation were included.
None.
Demographics, year of extracorporeal membrane oxygenation run, clinical variables, comorbid diagnoses, and extracorporeal membrane oxygenation complications were assessed in relation to the primary study outcome of survival to hospital discharge. Ninety patients were included in the final analysis. The overall survival rate for the study period was 19%. However, the survival rate in the last decade (2010-2019) improved to 26% (p = 0.01; odds ratio 9.4 [1.2-74.8]). Factors associated with decreased survival included comorbid malignancy, elevated peak inspiratory pressure in conventionally ventilated patients, and pulmonary and metabolic complications on extracorporeal membrane oxygenation.
Pediatric patients posthematopoietic stem cell transplantation supported with extracorporeal membrane oxygenation have improving survival rates over time. With 26% of patients (16/62) surviving to hospital discharge in the last decade (2010-2019), history of hematopoietic stem cell transplantation may no longer be considered an absolute contraindication to extracorporeal membrane oxygenation. As advancements are made in hematopoietic stem cell transplantation therapies and extracorporeal membrane oxygenation management, the indications for life-saving extracorporeal membrane oxygenation support among patients posthematopoietic stem cell transplantation may expand accordingly.
本研究旨在提供一份关于接受体外膜氧合治疗的儿科造血干细胞移植患者生存情况的最新综述，并描述与死亡率相关的人口统计学、临床变量和并发症特征。
对 1990 年至 2019 年期间体外生命支持组织登记处进行回顾性数据库审查。
向体外生命支持组织报告的体外膜氧合中心。
纳入年龄大于 28 天至 18 岁、采用国际疾病分类第 9 修订版、国际疾病分类第 10 修订版和当前程序术语代码的造血干细胞移植患者，这些代码与造血干细胞移植一致。
无。
评估人口统计学、体外膜氧合运行年份、临床变量、合并症诊断和体外膜氧合并发症与主要研究结果（即住院期间的生存）之间的关系。最终分析纳入 90 例患者。研究期间的总体生存率为 19%。然而，在过去十年（2010-2019 年），生存率提高至 26%（p=0.01；比值比 9.4[1.2-74.8]）。与生存率降低相关的因素包括合并恶性肿瘤、常规通气患者的峰值吸气压力升高，以及体外膜氧合的肺部和代谢并发症。
接受体外膜氧合支持的造血干细胞移植后儿科患者的生存率随时间推移而提高。在过去十年（2010-2019 年），有 26%（16/62）的患者存活至出院（p=0.01；比值比 9.4[1.2-74.8]）。因此，造血干细胞移植史可能不再被视为体外膜氧合的绝对禁忌证。随着造血干细胞移植治疗和体外膜氧合管理的进步，造血干细胞移植后患者进行救生性体外膜氧合支持的适应证可能会相应扩大。
