Department of Pediatrics, Augusta University, Augusta, Georgia, USA.
Department of Surgery, Augusta University, Augusta, Georgia, USA.
J Perinatol. 2023 Feb;43(2):196-202. doi: 10.1038/s41372-022-01503-5. Epub 2022 Sep 8.
Identify associations between cannulation approach and mortality in neonates who received ECMO support for respiratory failure.
A retrospective analysis of neonates receiving ECMO for respiratory indications at a single quaternary-referral NICU. Associations between cannulation approach and mortality were assessed after adjustment for Neo-RESCUERS score. Cox Proportional Hazards (CPH) model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for each variable and outcome.
Among 244 neonates, overall survival was 88%, with 71% undergoing VV cannulation. After adjusting for Neo-RESCUERS score, VA cannulation was associated with higher mortality during ECMO when compared with VV cannulation (HR 4.189, 95% CI 1.480-11.851, P = 0.0069). Disease-specific comparisons revealed no statistical difference in Neo-RESCUERS score between VA and VV cohorts; however, VA cannulation was associated with higher ECMO mortality for neonates with congenital diaphragmatic hernia (50% vs. 5.5%, Χ = 8.5965, P = 0.0034) and PPHN (20% vs. 1.8%, Χ = 9.1047, P = 0.0025) when compared with VV cannulation.
VA cannulation was associated with increased mortality in neonates while on ECMO for respiratory failure, which was independent of illness severity.
确定接受体外膜肺氧合（ECMO）支持治疗呼吸衰竭的新生儿的置管途径与死亡率之间的关联。
对一家四级转诊新生儿重症监护病房（NICU）接受 ECMO 治疗呼吸指征的新生儿进行回顾性分析。在调整了 Neo-RESCUERS 评分后，评估了置管途径与死亡率之间的关联。使用 Cox 比例风险（CPH）模型估计每个变量和结局的风险比（HR）和 95%置信区间（CI）。
在 244 名新生儿中，总体生存率为 88%，其中 71%接受了静脉-静脉（VV）置管。在调整了 Neo-RESCUERS 评分后，与 VV 置管相比，VA 置管与 ECMO 期间的死亡率更高（HR 4.189，95%CI 1.480-11.851，P=0.0069）。疾病特异性比较显示，VA 和 VV 队列之间的 Neo-RESCUERS 评分无统计学差异；然而，与 VV 置管相比，VA 置管与先天性膈疝（50%与 5.5%，Χ²=8.5965，P=0.0034）和新生儿持续性肺动脉高压（PPHN）（20%与 1.8%，Χ²=9.1047，P=0.0025）的新生儿 ECMO 死亡率更高相关。
VA 置管与接受 ECMO 治疗呼吸衰竭的新生儿死亡率增加相关，与疾病严重程度无关。
