Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Riley Hospital for Children, Indiana University Health, Indianapolis, IN, USA.
J Intensive Care Med. 2024 Mar;39(3):196-202. doi: 10.1177/08850666231193357. Epub 2023 Oct 29.
Extracorporeal membrane oxygenation (ECMO) is utilized as a rescue therapy in the management of pediatric patients with refractory septic shock. Multiple studies support the use of a central cannulation strategy in these patients. This study aimed to assess the survival of and identify mortality risk factors in pediatric patients supported with peripheral veno-arterial (VA) ECMO in the setting of septic shock.
We retrospectively reviewed and compared clinical characteristics of 40 pediatric patients supported with peripheral VA ECMO for refractory septic shock, at two tertiary care children's hospitals from 2006 to 2020. Our hypothesis was that peripheral VA ECMO is effective in supporting cardiac function and improving tissue oxygenation in most pediatric patients with refractory septic shock.
The overall rate of survival to discharge was 52.5%, comparable to previously reported survival for pediatric sepsis on ECMO. With the exclusion of patients with an oncologic process, the survival rate rose to 62.5%. There was a statistically significant difference in mean pump flow rates within 2 hours of initiation of ECMO between survivors and non-survivors (98 mL/kg/min vs 76 mL/kg/min, = .050). There was no significant difference between pre-ECMO vasoactive inotropic score (VIS) in survivors and non-survivors. A faster decrease in VIS in the first 24 hours was associated with lower mortality.
From this large case series, we conclude that peripheral VA ECMO is a safe and effective modality to support pediatric patients with refractory septic shock, provided there is establishment of high ECMO pump flows in the first few hours after cannulation and improvement in the VIS.
体外膜肺氧合（ECMO）被用作治疗小儿难治性感染性休克的抢救疗法。多项研究支持在这些患者中采用中央置管策略。本研究旨在评估在感染性休克背景下，采用外周静脉-动脉（VA）ECMO 支持的小儿患者的存活率，并确定其死亡风险因素。
我们回顾性分析并比较了 2006 年至 2020 年在两家三级儿童保健医院接受外周 VA ECMO 治疗难治性感染性休克的 40 例小儿患者的临床特征。我们的假设是，外周 VA ECMO 能够有效地支持心脏功能，并改善大多数难治性感染性休克患儿的组织氧合。
总体出院存活率为 52.5%，与之前 ECMO 治疗小儿败血症的存活率相当。排除有肿瘤过程的患者后，存活率上升至 62.5%。在 ECMO 开始后 2 小时内，存活组和死亡组的平均泵流量存在统计学显著差异（98 mL/kg/min 比 76 mL/kg/min， = 0.050）。存活组和死亡组的 ECMO 前血管活性正性肌力评分（VIS）无显著差异。在 24 小时内 VIS 更快下降与死亡率降低相关。
从这个大病例系列中，我们得出结论，外周 VA ECMO 是一种安全有效的治疗方法，可用于支持患有难治性感染性休克的小儿患者，前提是在置管后最初几个小时内建立高 ECMO 泵流量，并改善 VIS。
