小儿双向格林分流术和Fontan手术患者的复苏动脉波形量化与预后
Resuscitation arterial waveform quantification and outcomes in pediatric bidirectional Glenn and Fontan patients.
作者信息
Yates Andrew R, Hehir David A, Reeder Ron W, Berger John T, Fernandez Richard, Frazier Aisha H, Graham Kathryn, McQuillen Patrick S, Morgan Ryan W, Nadkarni Vinay M, Naim Maryam Y, Palmer Chella A, Wolfe Heather A, Berg Robert A, Sutton Robert M
机构信息
Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Pediatr Res. 2025 May;97(6):1989-1996. doi: 10.1038/s41390-024-03564-y. Epub 2024 Sep 16.
BACKGROUND
Resuscitation with chest compressions and positive pressure ventilation in Bidirectional Glenn (BDG) or Fontan physiology may compromise passive venous return and accentuate neurologic injury. We hypothesized that arterial pressure and survival would be better in BDG than Fontan patients.
METHODS
Secondary analyses of the Pediatric Intensive Care Quality of CPR and Improving Outcomes from Pediatric Cardiac Arrest databases. P-values were considered significant if < 0.05.
RESULTS
In total, 64 patients had either BDG (42/64, 66%) or Fontan (22/64, 34%) anatomy. Return of spontaneous circulation was achieved in 76% of BDG patients versus 59% of Fontan patients and survival with favorable neurologic outcome in 22/42 (52%) BDG versus 6/22 (27%) Fontan patients, p = 0.067. Twelve of 24 (50%) BDG and 2/7 (29%) Fontan patients who survived to discharge suffered new morbidity as defined by worsening Functional Status Score. More BDG patients achieved adequate DBP (≥25 mmHg for neonates and infants; ≥ 30 mmHg for children) than Fontan patients (21/23 (91%) vs. 5/11 (46%), p = 0.007).
CONCLUSIONS
Only 27% of Fontan patients survived to hospital discharge with favorable neurologic outcome after CPR, likely driven by inadequate diastolic blood pressure during resuscitation. One half of the BDG patients who survived to hospital discharge had new neurologic morbidity.
IMPACT STATEMENT
Hemodynamic waveforms from 2 large prospective observational studies now allow for exploration of physiology during cardiopulmonary resuscitation for unique anatomy associated with single ventricle congenital heart disease. Fewer patients with Fontan physiology (46%) achieved an adequate diastolic blood pressure (defined as ≥ 25 mmHg for neonates and infants and ≥ 30 mmHg for children) than bidirectional Glenn patients during cardiopulmonary resuscitation (91%, p = 0.007). Only 27% of Fontan patients survived to hospital discharge with favorable neurologic outcome after cardiopulmonary resuscitation. Of the bidirectional Glenn patients who survived, 50% developed a new morbidity as quantified by the Functional Status Score.
背景
在双向格林（BDG）或Fontan循环生理状态下进行胸外按压和正压通气复苏可能会损害被动静脉回流并加重神经损伤。我们假设BDG患者的动脉压和生存率会优于Fontan患者。
方法
对儿科重症监护心肺复苏质量和改善儿科心脏骤停结局数据库进行二次分析。P值<0.05被认为具有统计学意义。
结果
总共64例患者具有BDG（42/64，66%）或Fontan（22/64，34%）解剖结构。76%的BDG患者实现了自主循环恢复，而Fontan患者为59%；22/42（52%）的BDG患者和6/22（27%）的Fontan患者存活且神经功能预后良好，p = 0.067。在存活至出院的24例BDG患者中有12例（50%）和7例Fontan患者中有2例（29%）出现了根据功能状态评分恶化定义的新发疾病。达到足够舒张压（新生儿和婴儿≥25 mmHg；儿童≥30 mmHg）的BDG患者比Fontan患者更多（21/23（91%）对5/11（46%），p = 0.007）。
结论
CPR后只有27%的Fontan患者存活至出院且神经功能预后良好，这可能是由于复苏期间舒张压不足所致。存活至出院的BDG患者中有一半出现了新发神经疾病。
影响声明
两项大型前瞻性观察性研究的血流动力学波形现在允许探索与单心室先天性心脏病相关的独特解剖结构在心肺复苏期间的生理情况。在心肺复苏期间，达到足够舒张压（定义为新生儿和婴儿≥25 mmHg，儿童≥30 mmHg）的Fontan生理状态患者（46%）比双向格林患者（91%，p = 0.007）少。CPR后只有27%的Fontan患者存活至出院且神经功能预后良好。在存活的双向格林患者中，50%出现了根据功能状态评分量化的新发疾病。
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