Totapally Abhinav, Stark Ryan, Danko Melissa, Chen Heidi, Altheimer Alyssa, Hardison Daphne, Malone Matthew P, Zivick Elizabeth, Bridges Brian
Department of Pediatrics, Division of Pediatric Critical Care, Vanderbilt University Medical Center, Nashville, TN.
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN.
Pediatr Crit Care Med. 2025 Apr 1;26(4):e463-e472. doi: 10.1097/PCC.0000000000003692. Epub 2025 Jan 23.
Small studies of extracorporeal membrane oxygenation (ECMO) support for children with refractory septic shock (RSS) suggest that high-flow (≥ 150 mL/kg/min) venoarterial ECMO and a central cannulation strategy may be associated with lower odds of mortality. We therefore aimed to examine a large, international dataset of venoarterial ECMO patients for pediatric sepsis to identify outcomes associated with flow and cannulation site.
Retrospective analysis of the Extracorporeal Life Support Organization (ELSO) database from January 1, 2000, to December 31, 2021.
International pediatric ECMO centers.
Patients 18 years old young or younger without congenital heart disease (CHD) cannulated to venoarterial ECMO primarily for a diagnosis of sepsis, septicemia, or septic shock.
None.
Of 1242 pediatric patients undergoing venoarterial ECMO runs in the ELSO dataset, overall mortality was 55.6%. We used multivariable logistic regression analyses to evaluate explanatory factors associated with adjusted odds ratios (aORs) and 95% CI of mortality. In the regression analysis of data 4 hours after ECMO initiation, logarithm of the aOR, plotted against ECMO flow as a continuous variable, showed that higher flow was associated with lower aOR of mortality ( p = 0.03). However, at 24 hours, we failed to find such a relationship. Finally, peripheral cannulation, as opposed to central cannulation, was independently associated with greater odds of mortality (odds ratio, 1.7 [95% CI, 1.1-2.6]).
In this 2000-2021 international cohort of venoarterial ECMO for non-CHD children with sepsis, we have found that higher ECMO flow at 4 hours after support initiation, and central- rather than peripheral-cannulation, were both independently associated with lower odds of mortality. Therefore, flow early in the ECMO run and cannula location are two important factors to consider in future research in pediatric patients requiring cannulation to venoarterial ECMO for RSS.
关于体外膜肺氧合（ECMO）支持难治性脓毒性休克（RSS）患儿的小型研究表明，高流量（≥150 mL/kg/分钟）静脉-动脉ECMO和中心插管策略可能与较低的死亡几率相关。因此，我们旨在研究一个大型的国际小儿脓毒症静脉-动脉ECMO患者数据集，以确定与流量和插管部位相关的结局。
对体外生命支持组织（ELSO）数据库进行回顾性分析，时间跨度为2000年1月1日至2021年12月31日。
国际小儿ECMO中心。
18岁及以下无先天性心脏病（CHD）的患者，主要因脓毒症、败血症或脓毒性休克的诊断而接受静脉-动脉ECMO插管。
无。
在ELSO数据集中，1242例接受静脉-动脉ECMO治疗的小儿患者的总体死亡率为55.6%。我们使用多变量逻辑回归分析来评估与调整后的比值比（aORs）和死亡率的95%置信区间相关的解释因素。在ECMO启动后4小时的数据回归分析中，以连续变量形式绘制的aOR对数与ECMO流量的关系表明，较高的流量与较低的死亡率aOR相关（p = 0.03）。然而，在24小时时，我们未发现这种关系。最后，与中心插管相反，外周插管与更高的死亡几率独立相关（比值比，1.7 [95%置信区间，1.1 - 2.6]）。
在这个2000 - 2021年针对非CHD脓毒症患儿的国际静脉-动脉ECMO队列中，我们发现支持开始后4小时较高的ECMO流量以及中心而非外周插管均与较低的死亡几率独立相关。因此，ECMO运行早期的流量和插管位置是未来需要静脉-动脉ECMO插管治疗RSS的小儿患者研究中要考虑的两个重要因素。
