Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.
Department of Clinical Engineering, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.
Artif Organs. 2024 Nov;48(11):1346-1354. doi: 10.1111/aor.14826. Epub 2024 Jul 15.
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly utilized in pediatric patients. Failure to recognize membrane oxygenator failure can lead to critical complications due to rapid deterioration of membrane oxygenator function. Therefore, identifying the predictors for membrane oxygenator exchange is crucial. However, risk factors for membrane oxygenator exchange in pediatric V-A ECMO remain unclear; therefore, this study aimed to evaluate these risk factors.
This retrospective cohort study enrolled all pediatric patients aged <18 years who received V-A ECMO between August 2018 and July 2023 at a tertiary-care pediatric hospital in Japan. The Cox proportional hazards model was used to evaluate the predictors of membrane oxygenator failure within 72 h after initiation.
During the study period, membrane oxygenator failure occurred in 18/55 (32.7%) children within 72 h; membrane oxygenator failure within 72 h occurred in 4/29 (13.8%) and 14/26 (53.8%) in the groups with ratio of blood flow divided by the blood flow limit of the membrane oxygenator (B/L) of <0.5 and ≥0.5, respectively (adjusted hazards ratio, 4.97 [95% confidence interval, 1.33-18.5]; p = 0.017). After adjusting for delta pressure of the oxygenator, an increase in body weight and aspartate aminotransferase levels were associated with an increase in early membrane oxygenator failure.
This retrospective study demonstrated that a B/L ratio >0.5, an increase in body weight, and elevated aspartate aminotransferase were independent risk factors for early membrane oxygenator failure in pediatric V-A ECMO. However, a prospective multicenter study with an appropriate sample size is warranted to mitigate potential bias, and enhance generalizability for further investigation of the association between a B/L ratio and early membrane oxygenator failure.
静脉-动脉体外膜肺氧合（V-A ECMO）在儿科患者中应用日益增多。如果不能识别膜式氧合器故障，可能会导致膜式氧合器功能迅速恶化而引发严重并发症。因此，确定需要更换膜式氧合器的预测因素至关重要。然而，儿科 V-A ECMO 中需要更换膜式氧合器的风险因素仍不清楚；因此，本研究旨在评估这些风险因素。
本回顾性队列研究纳入了 2018 年 8 月至 2023 年 7 月在日本一家三级儿科医院接受 V-A ECMO 的所有年龄<18 岁的儿科患者。使用 Cox 比例风险模型评估启动后 72 小时内膜式氧合器衰竭的预测因素。
在研究期间，55 例患儿中有 18 例（32.7%）在 72 小时内发生膜式氧合器衰竭；B/L 比值<0.5 组的膜式氧合器衰竭发生在 4 例（13.8%），B/L 比值≥0.5 组的膜式氧合器衰竭发生在 14 例（53.8%）（调整后的风险比，4.97[95%置信区间，1.33-18.5]；p=0.017）。在校正了氧合器的压差、体重增加和天冬氨酸转氨酶水平后，早期膜式氧合器衰竭与体重增加和天冬氨酸转氨酶水平升高相关。
本回顾性研究表明，B/L 比值>0.5、体重增加和天冬氨酸转氨酶升高是儿科 V-A ECMO 中早期膜式氧合器衰竭的独立危险因素。然而，需要进行一项具有适当样本量的前瞻性多中心研究，以减轻潜在的偏倚，提高其普遍性，进一步研究 B/L 比值与早期膜式氧合器衰竭之间的关系。
