Agha Hala M, Fathalla Amr, Isgro Giuseppe, Cotza Mauro
Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Egypt.
Anaesthesia and Intensive Care Department, IRCCS, Policlinico San Donato, Milan, Italy.
J Saudi Heart Assoc. 2023 Jan 20;34(4):249-256. doi: 10.37616/2212-5043.1324. eCollection 2022.
Post-cardiotomy extracorporeal membrane oxygenation (ECMO) was associated with significant neurological complications affecting the overall outcome. The aim of the work is to determine the incidence and the predictors of neurological events during pediatric extracorporeal life support after cardiac surgery.
PATIENTS & METHODS: This is a retrospective study that encompassed all neonates, infants, and children (<18 years of age) who need extracorporeal life support following cardiac surgery between January 2015 and December 2018 at San Donato Hospital, Italy. Data as regards surgical procedure of congenital heart disease, in-hospital mortality, length of ECMO, hospital stay durations, short-term neurological ECMO complications and outcome were analyzed.
The sixty-three patients who received post-cardiotomy ECMO, Neurological complications were evident in 31.7% in the form of ischemic stroke in 17.5% and hemorrhagic stroke in 11.1%. By multivariable analysis, the older age of cyanotic cases, the need for a venting cannula, and the rapid CO2 drop in the first 24 h were the most independent risk factors for neurological complications. Prolonged ECMO support and hospital stay duration were associated with neurological sequelae.
Neurological complications either ischemic or hemorrhagic strokes were common during pediatric post-cardiotomy ECMO and were significantly related to prolonged ECMO support and hospital stay. Predictors of these neurological sequelae are the older cyanotic cases, the need for a venting cannula, the oxygenator thrombosis, and the rapid CO2 drop in the first 24 h of ECMO.
心脏手术后体外膜肺氧合（ECMO）与影响总体预后的严重神经系统并发症相关。本研究的目的是确定心脏手术后小儿体外生命支持期间神经系统事件的发生率和预测因素。
这是一项回顾性研究，纳入了2015年1月至2018年12月在意大利圣多纳托医院心脏手术后需要体外生命支持的所有新生儿、婴儿和儿童（<18岁）。分析了先天性心脏病的手术程序、院内死亡率、ECMO时长、住院时间、ECMO短期神经系统并发症及预后等数据。
接受心脏术后ECMO的63例患者中，31.7%出现神经系统并发症，其中17.5%为缺血性卒中，11.1%为出血性卒中。多变量分析显示，青紫型病例年龄较大、需要排气插管以及术后24小时内二氧化碳快速下降是神经系统并发症最独立的危险因素。延长ECMO支持时间和住院时间与神经系统后遗症相关。
小儿心脏术后ECMO期间，缺血性或出血性卒中的神经系统并发症很常见，且与延长ECMO支持时间和住院时间显著相关。这些神经系统后遗症的预测因素是年龄较大的青紫型病例、需要排气插管、氧合器血栓形成以及ECMO开始后24小时内二氧化碳快速下降。
