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Gran experiencia en un solo centro con la extubación durante la oxigenación extracorpórea neonatal y pediátrica
Caroline Holton1, Johanna Orrick2, Debra Newton2
1From the Division of Critical Care, Department of Pediatrics, University of Missouri-Kansas City and Children's Mercy Hospital, Kansas City, Missouri.
ASAIO journal (American Society for Artificial Internal Organs : 1992)
|August 25, 2025
Resumen
La extubación de pacientes pediátricos seleccionados con oxigenación por membrana extracorpórea (ECMO) es factible y segura. Este enfoque puede reducir la lesión pulmonar y mejorar los resultados de los pacientes, con una mayor tasa de supervivencia observada en pacientes extubados.
Área de la Ciencia:
- Medicina de cuidados intensivos pediátricos
- Apoyo cardiopulmonar
- Cuidados intensivos neonatales
Sus antecedentes:
- La extubación en pacientes neonatales y pediátricos con oxigenación de membrana extracorpórea (ECMO) puede prevenir la lesión pulmonar inducida por el ventilador, reducir la exposición a sedantes y mejorar la recuperación.
- Existen datos limitados sobre la viabilidad y seguridad de la extubación durante la ECMO en poblaciones pediátricas.
Objetivo del estudio:
- Para describir la experiencia de un solo centro con extubación de pacientes en ECMO.
- Evaluar los resultados y las complicaciones asociadas con la extubación en esta cohorte.
Principales métodos:
- Estudio de cohorte retrospectivo de pacientes sometidos a ECMO desde 2013 hasta 2022.
- Análisis de pacientes con ECMO extubados versus no extubados en unidades de cuidados intensivos cardíacos, pediátricos y neonatales.
- Comparación de las tasas de supervivencia y los perfiles de complicaciones.
Principales resultados:
- 40 pacientes (8,6% de las sesiones de ECMO) fueron extubados con ECMO, lo que representa la mayor cohorte pediátrica de un solo centro.
- Los pacientes extubados eran mayores, recibían soporte pulmonar y tenían recorridos ECMO más largos.
- La supervivencia al alta fue del 75% para los pacientes extubados, significativamente mayor que el grupo no extubado (p=0,044).
- El análisis ajustado mostró un aumento de la hemorragia gastrointestinal y el uso continuo de terapia de reemplazo renal (CRRT) en pacientes extubados, pero no un aumento de otras complicaciones importantes.
Conclusiones:
- La extubación en ECMO es una estrategia factible y segura en pacientes pediátricos seleccionados.
- Esta práctica se asocia con una mejor supervivencia al alta hospitalaria.
- Si bien algunas complicaciones como la hemorragia gastrointestinal y el uso de CRRT fueron más frecuentes, las complicaciones principales en general no aumentaron.
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