Shah Neel, Li Xilong, Shanmugham Prashanth, Fan Eddy, Thiagarajan Ravi R, Venkataraman Ramgopal, Raman Lakshmi
Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.
Department of Population and Data Science, University of Texas Southwestern Medical Center, Dallas, TX.
Pediatr Crit Care Med. 2023 Jul 1;24(7):541-550. doi: 10.1097/PCC.0000000000003216. Epub 2023 Mar 6.
Neurologic complications in pediatric patients supported by extracorporeal membrane oxygenation (ECMO) are common and lead to morbidity and mortality; however, few modifiable factors are known.
Retrospective study of the Extracorporeal Life Support Organization registry (2010-2019).
Multicenter international database.
Pediatric patients receiving ECMO (2010-2019) for all indications and any mode of support.
None.
We investigated if early relative change in Pa co2 or mean arterial blood pressure (MAP) soon after starting ECMO was associated with neurologic complications. The primary outcome of neurologic complications was defined as a report of seizures, central nervous system infarction or hemorrhage, or brain death. All-cause mortality (including brain death) was used as a secondary outcome.Out of 7,270 patients, 15.6% had neurologic complications. Neurologic complications increased when the relative Pa co2 decreased by greater than 50% (18.4%) or 30-50% (16.5%) versus those who had a minimal change (13.9%, p < 0.01 and p = 0.046). When the relative MAP increased greater than 50%, the rate of neurologic complications was 16.9% versus 13.1% those with minimal change ( p = 0.007). In a multivariable model adjusting for confounders, a relative decrease in Pa co2 greater than 30% was independently associated with greater odds of neurologic complication (odds ratio [OR], 1.25; 95% CI, 1.07-1.46; p = 0.005). Within this group, with a relative decrease in Pa co2 greater than 30%, the effects of increased relative MAP increased neurologic complications (0.05% per BP Percentile; 95% CI, 0.001-0.11; p = 0.05).
In pediatric patients, a large decrease in Pa co2 and increase in MAP following ECMO initiation are both associated with neurologic complications. Future research focusing on managing these issues carefully soon after ECMO deployment can potentially help to reduce neurologic complications.
接受体外膜肺氧合（ECMO）支持的儿科患者出现神经并发症很常见，会导致发病和死亡；然而，已知的可改变因素很少。
对体外生命支持组织注册库（2010 - 2019年）进行回顾性研究。
多中心国际数据库。
因所有适应症和任何支持模式接受ECMO治疗的儿科患者（2010 - 2019年）。
无。
我们研究了开始ECMO后不久Pa co2或平均动脉血压（MAP）的早期相对变化是否与神经并发症相关。神经并发症的主要结局定义为癫痫发作、中枢神经系统梗死或出血或脑死亡的报告。全因死亡率（包括脑死亡）用作次要结局。在7270例患者中，15.6%出现神经并发症。与变化最小的患者相比，当相对Pa co2下降超过50%（18.4%）或30 - 50%（16.5%）时，神经并发症增加（变化最小时为13.9%，p < 0.01和p = 0.046）。当相对MAP升高超过50%时，神经并发症发生率为16.9%，而变化最小时为13.1%（p = 0.007）。在调整混杂因素的多变量模型中，Pa co2相对下降超过30%与神经并发症的更高几率独立相关（比值比[OR]，1.25；95% CI，1.07 - 1.46；p = 0.005）。在该组中，随着Pa co2相对下降超过30%，相对MAP升高的影响增加了神经并发症（每血压百分位数增加0.05%；95% CI，0.001 - 0.11；p = 0.05）。
在儿科患者中，开始ECMO后Pa co2大幅下降和MAP升高均与神经并发症相关。未来聚焦于在ECMO应用后不久仔细管理这些问题的研究可能有助于减少神经并发症。
