Grim P F, Pope S K, Karlson K H, Taylor B J
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock.
Chest. 1994 Nov;106(5):1376-80. doi: 10.1378/chest.106.5.1376.
The effect of on-site extracorporeal membrane oxygenation (OS-ECMO) and selection criteria on the utilization rate of this technology is unknown. We retrospectively studied 55 neonates who were admitted to Arkansas Children's Hospital from 1985 to 1993. We compared the ECMO utilization, mortality, and morbidity rates for outborn neonates with moderate and severe persistent pulmonary hypertension (PPHN) before and after the establishment of an ECMO program with guidelines for its use at our institution. The rate of ECMO use was three times higher and the mortality rate was 13 times lower in the period after OS-ECMO compared with the period when ECMO was available only at other institutions. No differences were observed in the morbidity rates between the two periods. Physician decisions to initiate ECMO involved more than guidelines, since 37% of the increased ECMO use was not associated with use of the guidelines. Possible reasons for noncompliance with the guidelines are discussed. Neonates who had received medical therapy only and who had an oxygenation index > or = 30 and < 40 had no mortality. Our findings suggest that the need for ECMO in this group of neonates is low.
现场体外膜肺氧合（OS - ECMO）及其选择标准对该技术利用率的影响尚不清楚。我们回顾性研究了1985年至1993年期间入住阿肯色儿童医院的55名新生儿。我们比较了在我们机构建立具有使用指南的ECMO项目前后，患有中度和重度持续性肺动脉高压（PPHN）的外出生新生儿的ECMO利用率、死亡率和发病率。与仅在其他机构可使用ECMO的时期相比，OS - ECMO实施后的时期内，ECMO使用率高出三倍，死亡率降低了13倍。两个时期的发病率没有差异。启动ECMO的医生决策涉及的因素不止指南，因为增加的ECMO使用中有37%与指南的使用无关。讨论了不遵守指南的可能原因。仅接受过药物治疗且氧合指数≥30且<40的新生儿无死亡情况。我们的研究结果表明，这组新生儿对ECMO的需求较低。
