Department of Pediatric Critical Care, Cleveland Clinic Children's, Cleveland, OH, USA.
Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, MI, USA.
Pediatr Res. 2022 Sep;92(3):754-761. doi: 10.1038/s41390-022-02088-7. Epub 2022 May 3.
The rates, outcomes, and long-term trends of stroke complicating the use of extracorporeal membrane oxygenation (ECMO) have been inconsistently reported. We compared the outcomes of pediatric ECMO patients with and without stroke and described the frequency trends between 2000 and 2017.
Using the National Inpatient Sample (NIS) database, pediatric patients (age ≤18 years) who received ECMO were identified using ICD-9&10 codes. Binary, regression, and trend analyses were performed to compare patients with and without stroke.
A total of 114,477,997 records were reviewed. Overall, 28,695 (0.025%) ECMO patients were identified of which 2982 (10.4%) had stroke, which were further classified as hemorrhagic (n = 1464), ischemic (n = 1280), or combined (n = 238). Mortality was higher in the hemorrhagic and combined groups compared to patients with ischemic stroke and patients without stroke. Length of stay (LOS) was significantly longer in stroke vs. no-stroke patients. Hypertension and septicemia were more encountered in the hemorrhagic group, whereas the combined group demonstrated higher frequency of cardiac arrest and seizures.
Over the years, there is an apparent increase in the diagnosis of stroke. All types of stroke in ECMO patients are associated with increased LOS, although mortality is increased in hemorrhagic and combined stroke only.
Stroke is a commonly seen complication in pediatric patients supported by ECMO. Understanding the trends will help in identifying modifiable risk factors that predict poor outcomes in this patient population.
体外膜肺氧合（ECMO）并发卒中的发生率、结局和长期趋势报告结果不一。我们比较了并发和不并发卒中的儿科 ECMO 患者的结局，并描述了 2000 年至 2017 年之间的频率趋势。
使用国家住院患者样本（NIS）数据库，使用 ICD-9 和 10 代码识别接受 ECMO 的儿科患者（年龄≤18 岁）。采用二项式、回归和趋势分析比较有和无卒中的患者。
共回顾了 114477997 份记录。总体而言，有 28695（0.025%）例 ECMO 患者被确定为卒中，其中 2982（10.4%）例有卒中，进一步分为出血性（n=1464）、缺血性（n=1280）或混合性（n=238）。与缺血性卒中患者和无卒中患者相比，出血性和混合性卒中患者的死亡率更高。与无卒中患者相比，卒中患者的住院时间（LOS）明显更长。出血性组更常见高血压和败血症，而混合组更常发生心脏骤停和癫痫发作。
多年来，卒中的诊断明显增加。所有类型的 ECMO 患者卒中均与 LOS 延长相关，尽管只有出血性和混合性卒中患者的死亡率增加。
卒中是 ECMO 支持的儿科患者常见的并发症。了解这些趋势有助于确定可改变的风险因素，这些因素可预测该患者群体的不良结局。
