儿科难治性感染性休克中心静脉-动脉体外生命支持：单中心经验。
Central venoarterial extracorporeal life support in pediatric refractory septic shock: a single center experience.
机构信息
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
出版信息
Perfusion. 2022 May;37(4):385-393. doi: 10.1177/02676591211001782. Epub 2021 Mar 15.
OBJECTIVE
Venoarterial extracorporeal membrane oxygenation (VA ECMO) is recognized as a potential support therapy for pediatric patients with refractory septic shock (RSS). This review aims to report our experience with central VA cannulation in pediatric patients with RSS, and to compare this with peripheral VA ECMO cannulations for this condition at our institution.
DESIGN
Retrospective case series.
SETTING
Pediatric and cardiac intensive care units in an academic pediatric hospital.
PATIENTS
All patients 0-18 years old meeting criteria of RSS placed on VA ECMO between January 2011 and December 2018.
INTERVENTIONS
None.
MEASUREMENTS
Demographics, relevant clinical variables, ECMO run details, and outcomes were collected.
RESULTS
Between 2011 and 2018, 14 children were placed on VA ECMO for RSS. Nine were cannulated centrally, with the rest placed on peripheral VA ECMO. Overall survival to hospital discharge was 57.1% (8/14), with 66.7% of the central cannulation cohort surviving versus 40% in the peripheral cannulation (p = 0.34). Median ECMO duration was 147.1 hours (IQR: 91.9-178.6 hours), with survivors having a median length of 147.1 (IQR: 138.5-185.7) versus non survivors 114.7 hours (IQR: 63.7-163.5), p = 0.48. Overall median ICU length of stay (LOS) was 19 days (IQR: 10.5-42.2). The median % maximum flow achieved on VA ECMO was higher in the central cannulation group at 179.6% (IQR: 154.4-188.1) versus the peripheral with 133.5% (98.1-149.1), p = 0.01. Functional status scale (FSS) was used to capture morbidity. All survivors had a mean increase in their FSS from baseline. In the centrally cannulated group, 50% (4/8) received mediastinal exploration, but none developed mediastinitis. In terms of blood product utilization, the central cannulation received more platelets compared to the peripherally cannulated group (median 15.6 vs 3.3 mL/kg/day, p = 0.03).
CONCLUSION
A central approach to VA ECMO cannulation is feasible and has potential for good patient outcomes in selected patients.
目的
体外膜肺氧合（VA ECMO）被认为是治疗小儿难治性感染性休克（RSS）的潜在支持疗法。本研究旨在报告我们在小儿 RSS 患者中使用中心 VA 插管的经验，并与我院对此类患者使用外周 VA ECMO 插管进行比较。
设计
回顾性病例系列。
地点
学术儿科医院的儿科和心脏重症监护病房。
患者
2011 年 1 月至 2018 年 12 月期间，所有符合 RSS 标准并接受 VA ECMO 治疗的 0-18 岁患儿。
干预措施
无。
测量方法
收集人口统计学、相关临床变量、ECMO 运行细节和结局等数据。
结果
2011 年至 2018 年期间，14 名儿童因 RSS 接受 VA ECMO 治疗。9 名患儿接受中心插管，其余患儿接受外周 VA ECMO 插管。总体存活率为 57.1%（8/14），中心插管组的存活率为 66.7%，外周插管组的存活率为 40%（p=0.34）。中位 ECMO 持续时间为 147.1 小时（IQR：91.9-178.6 小时），存活者的中位 ECMO 持续时间为 147.1 小时（IQR：138.5-185.7），而非存活者为 114.7 小时（IQR：63.7-163.5），p=0.48。总体 ICU 住院时间（LOS）中位数为 19 天（IQR：10.5-42.2）。中心插管组 VA ECMO 最大流量百分比中位数为 179.6%（IQR：154.4-188.1），高于外周插管组的 133.5%（98.1-149.1），p=0.01。功能状态量表（FSS）用于评估发病率。所有存活者的 FSS 均较基线水平有所增加。在中心插管组中，50%（4/8）患儿接受了纵隔探查，但均未发生纵隔炎。在血液制品使用方面，中心插管组患儿接受的血小板中位数为 15.6 vs 3.3 mL/kg/天，明显高于外周插管组（p=0.03）。
结论
在选定的患者中，VA ECMO 中心插管是可行的，有获得良好患者结局的潜力。
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