Yang Yu, Gowda Sharada H, Hagan Joseph L, Hensch Lisa, Teruya Jun, Fernandes Caraciolo J, Hui Shiu-Ki R
Department of Pathology and Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
Vox Sang. 2022 Dec;117(12):1391-1397. doi: 10.1111/vox.13363. Epub 2022 Sep 19.
Blood transfusion is frequently needed to maintain adequate haemostasis and improve oxygenation for patients treated with extracorporeal membrane oxygenation (ECMO). It is more so for neonates with immature coagulation systems who require surgical intervention such as congenital diaphragmatic hernia (CDH) repair. There is growing evidence suggesting an association between blood transfusions and increased mortality. The aim of this study is to evaluate the association of blood transfusions during the peri-operative period of CDH repair, among other clinical parameters, with mortality in neonates undergoing on-ECMO CDH repair.
We performed a single centre retrospective chart review of all neonates with CDH undergoing on-ECMO surgical repair from January 2010 to December 2020. Logistic regression was used to investigate associations with survival status.
Sixty-two patients met the inclusion criteria. Platelet transfusions (odds ratio [OR] 1.42, 95% confidence interval [CI]: 1.06-1.90) in the post-operative period and ECMO duration (OR 1.17, 95% CI: 1.05-1.30) were associated with increased mortality. Major bleeding complications had the strongest association with mortality (OR 10.98, 95% CI: 3.27-36.91). Gestational age, birth weight, Apgar scores, sex, blood type, right versus left CDH, venovenous versus venoarterial ECMO and duration of ECMO before CDH repair and circuit change after adjusting for ECMO duration were not significantly associated with survival.
Platelet transfusion in the post-operative period and major bleeding are associated with increased mortality in CDH neonates with surgical repair. The data suggest a need to develop robust plans for monitoring and preventing coagulation aberrancies during neonatal ECMO support.
接受体外膜肺氧合（ECMO）治疗的患者常需输血以维持足够的止血功能并改善氧合。对于凝血系统未成熟且需要手术干预（如先天性膈疝（CDH）修复）的新生儿而言更是如此。越来越多的证据表明输血与死亡率增加之间存在关联。本研究的目的是评估在CDH修复围手术期输血及其他临床参数与接受ECMO支持的CDH修复新生儿死亡率之间的关联。
我们对2010年1月至2020年12月期间所有接受ECMO手术修复的CDH新生儿进行了单中心回顾性病历审查。采用逻辑回归分析来研究与生存状态的关联。
62例患者符合纳入标准。术后血小板输注（比值比[OR]1.42，95%置信区间[CI]：1.06 - 1.90）和ECMO持续时间（OR 1.17，95%CI：1.05 - 1.30）与死亡率增加相关。严重出血并发症与死亡率的关联最强（OR 10.98，95%CI：3.27 - 36.91）。在调整ECMO持续时间后，胎龄、出生体重、阿氏评分、性别、血型、右侧与左侧CDH、静脉 - 静脉与静脉 - 动脉ECMO以及CDH修复前的ECMO持续时间和回路更换与生存无显著关联。
术后血小板输注和严重出血与接受手术修复的CDH新生儿死亡率增加相关。数据表明需要制定强有力的计划，以监测和预防新生儿ECMO支持期间的凝血异常。
