Indiana University School of Medicine, Indianapolis, IN, USA.
Dow Medical College, Karachi, Sindh, Pakistan.
J Pediatr Surg. 2022 Sep;57(9):216-222. doi: 10.1016/j.jpedsurg.2021.11.020. Epub 2021 Dec 1.
BACKGROUND/PURPOSE: Decompressive laparotomy and open abdomen for abdominal compartment syndrome have been historically avoided during Extracorporeal Membrane Oxygenation (ECMO) due to seemingly elevated risks of bleeding and infection. Our goal was to evaluate a cohort of pediatric respiratory ECMO patients who underwent decompressive laparotomy with open abdomen at a single institution and to compare these patients to ECMO patients without open abdomen.
We reviewed all pediatric respiratory ECMO (30 days-18 years) patients treated with decompressive laparotomy with open abdomen at Riley Hospital for Children (1/2000-12/2019) and compared these patients to concurrent respiratory ECMO patients with closed abdomen. We excluded patients with surgical cardiac disease. We assessed demographics, ECMO data, and outcomes and defined significance as p = 0.05.
6 of 81 ECMO patients were treated with decompressive laparotomy and open abdomen. Open and closed abdomen groups had similar age (p = 0.223) and weight (0.286) at cannulation, but the open abdomen group had a higher reliance on vasoactive medications (Vasoactive Inotropic Score, p = 0.040). Open abdomen group survival was similar to closed abdomen patients (66.7%, vs 62.7%, p = 1). Open abdomen patients had lower incidence of ECMO complications (33.3% vs 83.6%, p = 0.014), but the groups had similar bleeding complications (p = 0.412) and PRBC transfusion volume (p = 0.941).
CONCLUSION/IMPACT: Pediatric ECMO patients with open abdomen after decompressive laparotomy had similar survival, blood products administered, and complications as those with a closed abdomen. An open abdomen is not a contra-indication to ECMO support in pediatric respiratory patients and should be considered in select patients.
背景/目的：在体外膜肺氧合 (ECMO) 期间，由于出血和感染的风险似乎升高，减压剖腹术和开放性腹部术式在历史上一直避免用于治疗腹腔间隔室综合征。我们的目标是评估在单个机构接受减压剖腹术和开放性腹部术式的一组小儿呼吸 ECMO 患者，并将这些患者与没有开放性腹部术式的 ECMO 患者进行比较。
我们回顾了所有在 Riley 儿童医院接受减压剖腹术和开放性腹部术式治疗的小儿呼吸 ECMO（30 天至 18 岁）患者（2000 年 1 月至 2019 年 12 月），并将这些患者与同期接受 ECMO 治疗且腹部闭合的患者进行比较。我们排除了患有外科心脏疾病的患者。我们评估了患者的人口统计学、ECMO 数据和结局，并将显著性定义为 p=0.05。
81 例 ECMO 患者中有 6 例接受了减压剖腹术和开放性腹部术式。开放性和闭合性腹部组在插管时的年龄（p=0.223）和体重（p=0.286）相似，但开放性腹部组对血管活性药物的依赖程度更高（血管活性正性肌力评分，p=0.040）。开放性腹部组的存活率与闭合性腹部组相似（66.7%，vs 62.7%，p=1）。开放性腹部组 ECMO 并发症的发生率较低（33.3%，vs 83.6%，p=0.014），但两组的出血并发症发生率相似（p=0.412），红细胞输注量也相似（p=0.941）。
结论/影响：接受减压剖腹术后接受开放性腹部术式的小儿 ECMO 患者的存活率、使用的血液制品和并发症与接受闭合性腹部术式的患者相似。开放性腹部术式不是小儿呼吸患者接受 ECMO 支持的禁忌症，在选择患者时应考虑该术式。
