Department of Surgery, University of Texas Medical Branch, Galveston, TX.
Department of Pediatrics, University of Oklahoma, Norman, OK.
Pediatr Crit Care Med. 2022 May 1;23(5):e240-e248. doi: 10.1097/PCC.0000000000002915. Epub 2022 Feb 28.
This study update in usage and outcomes of pediatric extracorporeal membrane oxygenation (ECMO) for patients with neoplasm analyzed according to demographics, clinical variables, and complications.
Retrospective database review of the Extracorporeal Life Support Organization registry from the last 2 decades (2000-2019). The data were divided between two decades in order to compare patients' backgrounds and outcomes over time.
ECMO centers reporting to Extracorporeal Life Support Organization.
Patients equal to or younger than 18 years old with International Classification of Diseases, 9th Revision and International Classification of Diseases, 10th Revision codes that referred to neoplasms who were managed with ECMO.
None.
Demographics, cancer subtype, clinical variables, and ECMO complications were assessed in relation to the primary study outcome of survival to hospital discharge. Nine-hundred two patients met inclusion criteria; 699 patients were in the latest decade, which is more than three times the number from the previous decade (203 patients). On univariate analysis, compared with the previous decade, in the later decade, ECMO was more frequently applied in patients with pre-ECMO cardiac arrest (31.3% vs 17.1%; p < 0.001), and/or lower oxygenation index (38.0 vs 48.1; p < 0.001). We failed to identify a difference in survival between the 2 decades (42.8% vs 37.9%; p = 0.218). On multivariable analysis, diagnosis of hematologic malignancy, post-cardiopulmonary resuscitation support type, hematopoietic stem cell transplant, and age older than seven were each associated with greater odds of mortality.
The use of ECMO in children with neoplasm has expanded over the latest decade with changes in patient selection. Mortality remains unchanged. Hence, although the clinician still should stay cautious in its application, ECMO can be considered as an option to rescue pediatric oncologic patients in the setting of worsening cardiopulmonary status in the PICU.
本研究更新了儿科体外膜肺氧合（ECMO）在肿瘤患者中的使用情况和结果，根据人口统计学、临床变量和并发症进行了分析。
回顾性分析了过去 20 年（2000-2019 年）体外生命支持组织登记处的数据库。为了比较患者随时间的背景和结果，将数据分为两个十年。
向体外生命支持组织报告的 ECMO 中心。
年龄等于或小于 18 岁，国际疾病分类第 9 版和国际疾病分类第 10 版代码指的是接受 ECMO 治疗的肿瘤患者。
无。
评估了人口统计学、癌症亚型、临床变量和 ECMO 并发症与主要研究结果（存活至出院）的关系。902 名患者符合纳入标准；其中 699 名患者来自最新的十年，是前十年（203 名）的三倍多。单因素分析显示，与前十年相比，在后十年中，ECMO 在接受 ECMO 前心脏骤停的患者中更常应用（31.3% vs 17.1%；p<0.001），且/或氧合指数较低（38.0 vs 48.1；p<0.001）。我们没有发现两个十年之间的生存率有差异（42.8% vs 37.9%；p=0.218）。多变量分析显示，血液恶性肿瘤诊断、心肺复苏后支持类型、造血干细胞移植和年龄大于 7 岁均与死亡率增加相关。
在最近十年中，儿童肿瘤患者中 ECMO 的使用有所增加，患者选择也发生了变化。死亡率保持不变。因此，尽管临床医生在应用 ECMO 时仍应保持谨慎，但在儿科重症监护病房心肺功能恶化时，ECMO 可以被认为是挽救儿科肿瘤患者的一种选择。
