Critical Care, Nemours Children's Health Delaware, Wilmington, Delaware, USA.
Pediatric Critical Care, Memorial Care, Fountain Valley, California, USA.
Artif Organs. 2023 Oct;47(10):1632-1640. doi: 10.1111/aor.14595. Epub 2023 Jun 19.
Extracorporeal life support (ECLS) for status asthmaticus (SA) is rare. Increased safety and experience may increase utilization of ECLS for SA.
We reviewed pediatric (<18 years old) patients requiring ECLS for SA between 1998 and 2019 within the Extracorporeal Life Support Organization (ELSO) Registry and Nemours Children's Health (NCH) system. We compared patient characteristics, pre-ECLS medications, clinical data, complications, and survival to discharge between Early (1988-2008) and Late (2009-2019) eras.
From the ELSO Registry, we identified 173 children, 53 in Early and 120 in Late eras, with primary diagnosis of SA. Pre-ECLS hypercarbic respiratory failure was similar between eras (median pH 7.0 and pCO 111 mm Hg). Venovenous mode (79% vs. 82%), median ECLS time (116 vs. 99 h), time to extubation (53 vs. 62 h), and hospital survival (89% vs. 88%) also remained similar. Intubation to cannulation time significantly decreased (20 vs. 10 h, p = 0.01). ECLS without complication occurred more in the Late era (19% vs. 39%, p < 0.01), with decreased hemorrhagic (24% vs. 12%, p = 0.05) and noncannula-related mechanical (19% vs. 6%, p = 0.008) complications. Within NCH, we identified six Late era patients. Pre-ECLS medication favored intravenous beta agonists, bronchodilators, magnesium sulfate, and steroids. One patient died from neurological complications following pre-ECLS cardiac arrest.
Collective experience supports ECLS as a rescue therapy for pediatric SA. Survival to discharge remains good, and complication rates have improved. Pre-ECLS cardiac arrest may potentiate neurologic injury and impact survival. Further study is needed to evaluate causal relationships between complications and outcomes.
体外生命支持（ECLS）治疗哮喘持续状态（SA）较为少见。安全性和经验的提高可能会增加 ECLS 在 SA 中的应用。
我们对 1998 年至 2019 年期间在体外生命支持组织（ELSO）登记处和 Nemours 儿童健康（NCH）系统中接受 ECLS 治疗的小儿（<18 岁）哮喘持续状态患者进行了回顾性研究。我们比较了两个时期（早期：1988-2008 年；晚期：2009-2019 年）患者的特征、ECLS 前用药、临床数据、并发症和出院存活率。
在 ELSO 登记处，我们共确定了 173 名患儿，其中早期 53 名，晚期 120 名，主要诊断为 SA。ECLS 前高碳酸血症性呼吸衰竭在两个时期相似（中位 pH 值 7.0 和 pCO2 111mmHg）。静脉-静脉模式（79%比 82%）、中位 ECLS 时间（116 比 99h）、拔管时间（53 比 62h）和住院存活率（89%比 88%）也相似。插管到置管时间明显缩短（20 比 10h，p=0.01）。晚期 ECLS 无并发症的发生率更高（19%比 39%，p<0.01），出血性并发症（24%比 12%，p=0.05）和非插管相关机械并发症（19%比 6%，p=0.008）减少。在 NCH，我们共确定了 6 名晚期患儿。ECLS 前用药倾向于静脉内β受体激动剂、支气管扩张剂、硫酸镁和类固醇。1 名患儿在 ECLS 前心脏骤停后出现神经并发症死亡。
综合经验支持 ECLS 作为小儿 SA 的抢救治疗。出院存活率仍然较高，并发症发生率有所改善。ECLS 前心脏骤停可能会加重神经损伤并影响存活率。需要进一步研究以评估并发症与结局之间的因果关系。
