小儿体外膜肺氧合的短期神经学转归与一种新型出血量表所分级的出血严重程度成正比。
Short-term neurologic outcomes in pediatric extracorporeal membrane oxygenation are proportional to bleeding severity graded by a novel bleeding scale.
作者信息
Doane Katherine, Guffey Danielle, Loftis Laura L, Nguyen Trung C, Musick Matthew A, Ruth Amanda, Coleman Ryan D, Teruya Jun, Allen Christine, Bembea Melania M, Boville Brian, Furlong-Dillard Jamie, Kaipa Santosh, Leimanis Mara, Malone Matthew P, Rasmussen Lindsey K, Said Ahmed, Steiner Marie E, Tzanetos Deanna T, Viamonte Heather, Wallenkamp Linda, Saini Arun
机构信息
Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA.
出版信息
Perfusion. 2024 Oct 18:2676591241293673. doi: 10.1177/02676591241293673.
INTRODUCTION
This study aimed to characterize the severity of bleeding and its association with short-term neurologic outcomes in pediatric ECMO.
METHODS
Multicenter retrospective cohort study of pediatric ECMO patients at 10 centers utilizing the Pediatric ECMO Outcomes Registry (PEDECOR) database from December 2013-February 2019. Subjects excluded were post-cardiac surgery patients and those with neonatal pathologies. A novel ECMO bleeding scale was utilized to categorize daily bleeding events. Poor short-term neurologic outcome was defined as an unfavorable Pediatric Cerebral Performance Category (PCPC) or Pediatric Overall Performance Category (POPC) (score of >3) at hospital discharge.
RESULTS
This study included 283 pediatric ECMO patients with a median (interquartile range [IQR]) age of 1.3 years [0.1, 9.0], ECMO duration of 5 days [3.0, 9.5], and 44.1% mortality. Unfavorable PCPC and POPC were observed in 48.4% and 51.3% of patients at discharge, respectively. Multivariable logistic regression analysis included patient's age, cannulation type, duration of ECMO, need for cardiopulmonary resuscitation, acute kidney injury, new infection, and vasoactive-inotropic score. As the severity of bleeding increased, there was a corresponding increase in the likelihood of poor neurologic recovery, shown by increasing odds of unfavorable neurologic outcome (PCPC), with an adjusted odds ratio (aOR) of 0.77 (confidence interval [CI] 0.36-1.62), 1.87 (0.54-6.45), 2.97 (1.32-6.69), and 5.56 (0.59-52.25) for increasing bleeding severity (grade 1 to 4 events, respectively). Similarly, unfavorable POPC aOR (CI) was 1.02 (0.48-2.17), 2.05 (0.63-6.70), 5.29 (2.12-13.23), and 5.11 (0.66-39.64) for bleeding grade 1 to 4 events.
CONCLUSION
Short-term neurologic outcomes in pediatric ECMO are proportional to the severity of bleeding events. Strategies to mitigate bleeding events could improve neurologic recovery in pediatric ECMO.
引言
本研究旨在描述小儿体外膜肺氧合（ECMO）中出血的严重程度及其与短期神经学预后的关系。
方法
利用2013年12月至2019年2月的小儿ECMO结局登记数据库（PEDECOR），对10个中心的小儿ECMO患者进行多中心回顾性队列研究。排除的受试者为心脏手术后患者和患有新生儿疾病的患者。采用一种新的ECMO出血量表对每日出血事件进行分类。短期神经学预后不良定义为出院时小儿脑功能分类（PCPC）或小儿总体功能分类（POPC）不良（评分>3）。
结果
本研究纳入283例小儿ECMO患者，中位（四分位间距[IQR]）年龄为1.3岁[0.1, 9.0]，ECMO持续时间为5天[3.0, 9.5]，死亡率为44.1%。出院时分别有48.4%和51.3%的患者出现不良PCPC和POPC。多变量逻辑回归分析包括患者年龄、插管类型、ECMO持续时间、心肺复苏需求、急性肾损伤、新发感染和血管活性药物评分。随着出血严重程度的增加，神经功能恢复不良的可能性相应增加，表现为不良神经学预后（PCPC）的比值比增加，出血严重程度增加（分别为1至4级事件）时，调整后的比值比（aOR）为0.77（置信区间[CI] 0.36 - 1.62）、1.87（0.54 - 6.45）、2.97（1.32 - 6.69）和 5.56（0.59 - 52.25）。同样，出血1至4级事件的不良POPC的aOR（CI）分别为1.02（0.48 - 2.17）、2.05（0.63 - 6.70）、5.29（2.12 - 13.23）和5.11（0.66 - 39.64）。
结论
小儿ECMO的短期神经学预后与出血事件的严重程度成正比。减轻出血事件的策略可改善小儿ECMO的神经功能恢复。
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