Esangbedo Ivie, Brogan Thomas, Chan Titus, Tjoeng Yuen Lie, Brown Marshall, McMullan D Michael
Department of Pediatrics, Division of Cardiac Critical Care Medicine, University of Washington Seattle Children's Hospital Seattle WA United States.
Department of Pediatrics, Division of Critical Care Medicine, University of Washington Seattle Children's Hospital Seattle WA United States.
Resuscitation. 2025 Feb;207:110490. doi: 10.1016/j.resuscitation.2025.110490. Epub 2025 Jan 6.
While several studies have reported on outcomes of extracorporeal membrane oxygenation (ECMO) in patients with single ventricle physiology, few studies have described outcomes of extracorporeal cardiopulmonary resuscitation (ECPR) in this unique population. The objective of this study was to determine survival and risk factors for mortality after ECPR in single ventricle patients prior to superior cavopulmonary anastomosis, using a large sample from the Extracorporeal Life Support Organization (ELSO) Registry.
We included single ventricle patients who underwent ECPR for in-hospital cardiac arrest (IHCA) between January 2012 and December 2021. We excluded patients who had undergone a superior cavopulmonary anastomosis, inferior cavopulmonary anastomosis, or who were older than 180 days at the time of ECPR. We collected data on mortality, ECMO course and ECMO complications. Subjects who survived to hospital discharge after ECPR were compared to subjects who did not survive to hospital discharge. We then performed univariate logistic regression followed by multivariable logistic regression analysis for associations with survival to hospital discharge.
There were 420 subjects included who had index ECPR events. Median age was 14 (IQR 7,44) days and median weight was 3.14 (IQR 2.8, 3.8) kg.. Hypoplastic left heart syndrome was the most common diagnosis (354/420; 84.2%), and 47.4% of the cohort (199/420) had undergone a Norwood operation. Survival to hospital discharge occurred in 159/420 (37.9%) of subjects. Median number of hours on ECMO (122 vs. 93 h; p < 0.001), presence of seizures by electroencephalography (24% vs. 15%; p = 0.033), and need for renal replacement therapy (45% vs. 34%; p = 0.023) were significantly higher among non-survivors compared to survivors. In the subgroup of Norwood patients, survival was 43.2% after ECPR. Presence of Norwood variable was 54% among ECPR survivors in the overall cohort, compared to 43% among non-survivors (p = 0.032). In a multivariable logistic regression model to test association with survival to discharge, number of ECMO hours and presence of seizures were associated with decreased odds of survival to hospital discharge [adjusted odds ratio 0.95 (95% C.I. 0.92-0.98) and 0.57 (95% C.I. 0.33-0.97) respectively]. The odds ratio for ECMO hours demonstrated a decrease in odds of survival by 5% for every 12 h on ECMO. Presence of Norwood operation pre-arrest was associated with increased odds of survival [adjusted odds ratio 1.53 (95% C.I. 1.01-2.32)].
In our cohort of pre-Glenn single ventricle infants, survival after ECPR for in-hospital cardiac arrest was 37.9%. Number of hours on ECMO and seizures post-ECMO cannulation were associated with decreased odds of survival. Single ventricle infants who had undergone Norwood palliation pre-arrest were more likely to survive to hospital discharge.
虽然多项研究报告了体外膜肺氧合（ECMO）用于单心室生理患者的治疗结果，但很少有研究描述这种特殊人群的体外心肺复苏（ECPR）结果。本研究的目的是利用体外生命支持组织（ELSO）登记处的大量样本，确定单心室患者在进行上腔静脉肺动脉吻合术前接受ECPR后的生存率和死亡风险因素。
我们纳入了2012年1月至2021年12月期间因院内心脏骤停（IHCA）接受ECPR的单心室患者。我们排除了已接受上腔静脉肺动脉吻合术、下腔静脉肺动脉吻合术的患者，或在进行ECPR时年龄超过180天的患者。我们收集了死亡率、ECMO治疗过程和ECMO并发症的数据。将ECPR后存活至出院的受试者与未存活至出院的受试者进行比较。然后进行单因素逻辑回归，接着进行多因素逻辑回归分析，以确定与存活至出院的相关性。
共有420名受试者发生首次ECPR事件。中位年龄为14（四分位间距7,44）天，中位体重为3.14（四分位间距2.8, 3.8）kg。左心发育不全综合征是最常见的诊断（354/420；84.2%），队列中的47.4%（199/420）接受了诺伍德手术。159/420（37.9%）的受试者存活至出院。与存活者相比，非存活者的ECMO中位小时数（122 vs. 93小时；p < 0.001）、脑电图显示有癫痫发作（24% vs. 15%；p = 0.033）以及需要肾脏替代治疗（45% vs. 34%；p = 0.023）显著更高。在诺伍德患者亚组中，ECPR后的生存率为43.2%。在整个队列中，ECPR存活者中诺伍德变量的存在率为54%，而非存活者中为43%（p = 0.032）。在一个用于检验与存活至出院相关性的多因素逻辑回归模型中，ECMO小时数和癫痫发作与存活至出院的几率降低相关[调整后的优势比分别为0.95（95%置信区间0.92 - 0.98）和0.57（95%置信区间0.33 - 0.97）]。ECMO小时数的优势比显示，每进行12小时ECMO，存活几率降低5%。心脏骤停前接受诺伍德手术与存活几率增加相关[调整后的优势比1.53（95%置信区间1.01 - 2.32）]。
在我们这组格伦手术前的单心室婴儿队列中，因院内心脏骤停接受ECPR后的生存率为37.9%。ECMO小时数和ECMO插管后癫痫发作与存活几率降低相关。心脏骤停前接受诺伍德姑息治疗的单心室婴儿更有可能存活至出院。
