Flores Saul, Loomba Rohit S, Mastropietro Christopher W, Cheung Eva, Amula Venugopal, Radman Monique R, Kwiatkowski David M, Puente Bao N, Buckley Jason R, Allen Kiona Y, Karki Karan B, Chiwane Saurabh, Cashen Katherine, Piggott Kurt, Kapileshwarkar Yamini, Gowda Keshava M N, Badheka Aditya, Raman Rahul, Zang Huaiyu, Costello John M, Iliopoulos Ilias
Department of Pediatrics, Division of Critical Care and Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, 14th Floor, Houston, TX, 77030, USA.
Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Pediatr Cardiol. 2025 Jan 10. doi: 10.1007/s00246-024-03764-7.
Data on outcomes of extracorporeal membrane oxygenation (ECMO) are limited in patients with pulmonary atresia intact ventricular septum (PAIVS). The objective of this study was to describe the use of ECMO and the associated outcomes in patients with PAIVS. We retrospectively reviewed neonates with PAIVS who received ECMO between 2009 and 2019 in 19 US hospitals affiliated with the Collaborative Research for the Pediatric Cardiac Intensive Care Society (CoRe-PCICS). Patients who received ECMO were compared to those who did not and patients on ECMO who died were compared to those who survived by bivariate analysis and multivariable logistic regression. The predictive ability of a risk score for inpatient mortality (using beta coefficients) was assessed by receiver operator curve analysis. Of 295 identified patients, 32 (11%) were supported with extracorporeal membrane oxygenation. Of these, 15 (46%) experienced mortality. A higher left pulmonary artery z-score (beta coefficient 0.72) and the presence of ventriculocoronary connections by cardiac catheterization (beta coefficient 1.25) were associated with an increased risk of ECMO (p-value < 0.01). The resulting risk score had an area under the curve of 0.71 (p-value 0.03) for the prediction of need for ECMO. In a multicenter cohort of patients with PAIVS, 11% received ECMO. Of those supported with ECMO, 46% experienced inpatient mortality. A higher left pulmonary artery z-score and the presence of ventriculocoronary connections appear to be risk factors for the use of ECMO.
关于体外膜肺氧合（ECMO）在室间隔完整型肺动脉闭锁（PAIVS）患者中的治疗结果数据有限。本研究的目的是描述PAIVS患者使用ECMO的情况及相关治疗结果。我们回顾性分析了2009年至2019年间在美国小儿心脏重症监护协会合作研究（CoRe-PCICS）下属的19家医院接受ECMO治疗的PAIVS新生儿。通过双变量分析和多变量逻辑回归，将接受ECMO治疗的患者与未接受治疗的患者进行比较，并将接受ECMO治疗死亡的患者与存活患者进行比较。通过受试者操作特征曲线分析评估住院死亡率风险评分（使用β系数）的预测能力。在295名确诊患者中，32名（11%）接受了体外膜肺氧合支持。其中，15名（46%）死亡。左肺动脉z评分较高（β系数0.72）以及心导管检查发现心室冠状动脉连接（β系数1.25）与ECMO使用风险增加相关（p值<0.01）。所得风险评分预测ECMO需求的曲线下面积为0.71（p值0.03）。在一个多中心PAIVS患者队列中，11%接受了ECMO治疗。在接受ECMO支持的患者中，46%在住院期间死亡。较高的左肺动脉z评分和心室冠状动脉连接的存在似乎是使用ECMO的危险因素。
