儿科体外生命支持治疗难治性哮喘持续状态：ELSO 注册研究过去十年的趋势。

Pediatric extracorporeal life support for refractory status asthmaticus: ELSO Registry trends from the past decade.

机构信息

Critical Care, Nemours Children's Health Delaware, Wilmington, Delaware, USA.

Pediatric Critical Care, Memorial Care, Fountain Valley, California, USA.

出版信息

Artif Organs. 2023 Oct;47(10):1632-1640. doi: 10.1111/aor.14595. Epub 2023 Jun 19.

DOI:10.1111/aor.14595

PMID:37270689

Abstract

BACKGROUND

Extracorporeal life support (ECLS) for status asthmaticus (SA) is rare. Increased safety and experience may increase utilization of ECLS for SA.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

摘要

背景

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。

方法

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。

结果

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。