Neonatal and Pediatric Intensive Care Unit, Trousseau Hospital, AP-HP, Paris, France.
Medicine Department, Sorbonne University, Paris, France.
Artif Organs. 2024 Aug;48(8):831-838. doi: 10.1111/aor.14754. Epub 2024 Apr 22.
Extracorporeal membrane oxygenation (ECMO) is widely used for children treated for refractory respiratory failures or refractory cardiogenic shock. Its duration depends on organ functions recovery. Weaning is decided using macro-circulatory tools, but microcirculation is not well evaluated. Sidestream dark-field video imaging is used to assess the perfusion of the sublingual microvascular vessels. The aim of this study was to assess the predictive value of microcirculatory indices in ECMO weaning.
This prospective monocentric study examined pediatric patients at Trousseau Hospital between March 2017 and December 2020. The study included all patients from 35 weeks of gestational age to 18 years old who were treated with ECMO. Children were divided into two groups: one with stability after weaning and the other with instability after weaning. We collected clinical and biological data, ventilation parameters, extracorporeal membrane oxygenation parameters, and drugs used at admission and after the weaning test. Microcirculations videos were taken after weaning trials with echocardiography and blood gas monitoring.
The study included 30 patients with a median age of 29 days (range: 1-770 days) at admission, including 18 patients who received venoarterial ECMO (60%). There were 19 children in the stability group and 11 in the instability group. Macrocirculatory and microcirculatory indices showed no differences between groups. The microvascular flow index was subnormal in both groups (2.3 (1.8-2.4) and 2.3 (2.3-2.6), respectively; p = 0.24). The microvascular indices were similar between cases of venovenous and venoarterial ECMO and between age groups.
Microcirculation monitoring at the weaning phase did not predict the failure of ECMO weaning.
体外膜肺氧合（ECMO）广泛应用于治疗难治性呼吸衰竭或难治性心源性休克的儿童。其持续时间取决于器官功能的恢复。撤机使用宏观循环工具来决定，但微循环评估不佳。侧流暗场视频成像用于评估舌下微血管的灌注。本研究旨在评估微循环指标在 ECMO 撤机中的预测价值。
这是一项前瞻性单中心研究，在 2017 年 3 月至 2020 年 12 月期间对特鲁瓦索医院的儿科患者进行了检查。该研究纳入了所有胎龄 35 周至 18 岁接受 ECMO 治疗的患者。患儿分为两组：撤机后稳定组和撤机后不稳定组。我们收集了入院时和撤机试验后的临床和生物学数据、通气参数、体外膜肺氧合参数以及使用的药物。撤机试验后，在超声心动图和血气监测下采集微循环视频。
研究纳入了 30 名患儿，入院时的中位年龄为 29 天（范围：1-770 天），其中 18 名患儿接受了静脉-动脉 ECMO（60%）。稳定组 19 例，不稳定组 11 例。两组间宏观循环和微循环指标无差异。两组的微血管血流指数均低于正常（分别为 2.3（1.8-2.4）和 2.3（2.3-2.6）；p=0.24）。静脉-静脉 ECMO 和静脉-动脉 ECMO 之间以及年龄组之间的微血管指数相似。
撤机阶段的微循环监测不能预测 ECMO 撤机失败。
