Multiple Pediatric Extracorporeal Membrane Oxygenation Runs and Futility. What Are the Limits?

IF 3.1 3区 医学 Q2 ENGINEERING, BIOMEDICAL
Justus G Reitz, Areen Almarkhan, Rittal Mehta, Arif Selcuk, Dana Harrar, Manan Desai, Guillermo Herrera, In Hye Park, Aybala Tongut, Yves d'Udekem, Sarah Schlatterer
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Abstract

Despite high mortality rates, pediatric extracorporeal membrane oxygenation (ECMO) redeployments are frequently discussed in everyday clinical care. We aim to investigate predictors of mortality in those patients. Clinical data from a single pediatric center were retrospectively analyzed. Patients with multiple ECMO runs between 2010 and 2023 were included. A total of 70 (13%) patients required multiple ECMO runs. Of those, 56 (80%) died before discharge; late mortality was 89% at a median of 1.6 (1.0-3.9) years. A total of 47 (67%) patients had neurologic findings. Only one (1%) survivor had a normal neurodevelopmental follow-up. Duration of the first ECMO run (odds ratio [OR]: 2.63, 1.08-7.96), total duration on ECMO (OR: 4.72, 1.29-23.54), neurologic findings at any time (OR: 7.94, 1.46-43.24), need for renal replacement therapy (OR: 4.79, 1.06-25.58), and lactate values correlated with late mortality. All 19 (27%) patients with neurologic findings before the second run died. The frequency of multiple-run ECMOs increased within the study period. Outcomes in pediatric patients with multiple ECMO runs are disheartening. Given all patients in our cohort with neurological findings before the second ECMO run died, neurological findings should be taken into consideration when determining the utility of further ECMO support.

多次小儿体外膜氧合运行与无用论。极限是什么?
尽管死亡率很高,但儿科体外膜肺氧合(ECMO)的重新部署在日常临床护理中经常被讨论。我们旨在研究这些患者的死亡率预测因素。我们对一家儿科中心的临床数据进行了回顾性分析。研究纳入了在 2010 年至 2023 年期间进行过多次 ECMO 运行的患者。共有 70 名(13%)患者需要进行多次 ECMO 运行。其中,56 人(80%)在出院前死亡;在中位 1.6(1.0-3.9)年时,晚期死亡率为 89%。共有 47 名(67%)患者出现神经系统症状。只有一名(1%)幸存者的神经发育随访正常。首次 ECMO 运行的持续时间(比值比 [OR]:2.63,1.08-7.96)、ECMO 的总持续时间(比值比:4.72,1.29-23.54)、任何时间的神经系统检查结果(比值比:7.94,1.46-43.24)、肾脏替代治疗需求(比值比:4.79,1.06-25.58)和乳酸值与晚期死亡率相关。第二次运行前出现神经症状的 19 名患者(27%)全部死亡。在研究期间,多次运行 ECMO 的频率有所增加。多次运行 ECMO 的儿科患者的结局令人沮丧。鉴于我们队列中所有在第二次 ECMO 运行前出现神经系统检查结果的患者均已死亡,在确定进一步 ECMO 支持的效用时,应将神经系统检查结果考虑在内。
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来源期刊
ASAIO Journal
ASAIO Journal 医学-工程:生物医学
CiteScore
6.60
自引率
7.10%
发文量
651
审稿时长
4-8 weeks
期刊介绍: ASAIO Journal is in the forefront of artificial organ research and development. On the cutting edge of innovative technology, it features peer-reviewed articles of the highest quality that describe research, development, the most recent advances in the design of artificial organ devices and findings from initial testing. Bimonthly, the ASAIO Journal features state-of-the-art investigations, laboratory and clinical trials, and discussions and opinions from experts around the world. The official publication of the American Society for Artificial Internal Organs.
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