在儿科创伤复苏中使用ECMO:当代多中心研究
Mary E Moya-Mendez1, Victoria Donohue, Harold Leraas
1From the Division of Pediatric Surgery (M.E.M-M., H.L., D.B., E.T.T.), Duke Children's Hospital and Health Center, Durham, North Carolina; Department of Pediatrics (V.D.), Children's Hospital Los Angeles, Los Angeles, California; Division of Pediatric General and Thoracic Surgery (J.G., C.G.M.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pediatric Critical Care (T.W., T.H.), University Health Women's and Children's Hospital, University of Texas Health San Antonio, San Antonio, Texas; Division of Pediatric Critical Care (K.E.), Penn State Health Children's Hospital, Penn State College of Medicine, Hershey, Pennsylvania; Division of Pediatric Surgery (A.Y., H.M.P.), Washington University in St. Louis / St. Louis Children's Hospital, St. Louis, Missouri; Division of Critical Care Medicine, Department of Pediatrics (M.P.M., D.W.), University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas; Division of Pediatric Critical Care Medicine (S.R.B.), Oklahoma Children's Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Division of Pediatric Critical Care Medicine (M.C.), Stead Family Children's Hospital, University of Iowa, Iowa City, Iowa; Division of Critical Care, Department of Pediatrics (J.F-D.), Norton Children's Hospital, Louisville, Kentucky; Division of Pediatric Surgery (B.W.G., S.V.M.), Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana; Pediatric Intensive Care Unit (M.D.N.), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; and Division of Pediatric Surgery, Department of Surgery (C.O.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
身体外膜氧化 (ECMO) 为儿科创伤患者提供了与非创伤病例相比的生存率. 在儿科创伤中早期使用ECMO,特别是在呼吸道受伤或溺水时,显示出有希望的生存益处.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 创伤外科 手术 创伤外科
- 支持心肺血管的支持.
背景情况:
- 创伤是儿童死亡的主要原因.
- 在儿科创伤中,体外膜氧化 (ECMO) 的疗效尚未得到充分证实.
- 了解儿童创伤中的当代ECMO实践至关重要.
研究的目的:
- 评估当前儿童创伤的ECMO实践模式.
- 为了比较ECMO在急性 (<24小时) 和亚急性 (≥24小时) 环境中的使用情况.
- 根据创伤机制和ECMO启动时间分析结果.
主要方法:
- 对接受ECMO创伤后治疗的儿童 (0-20岁) 进行多中心回顾性研究.
- 收集关于创伤类型,ECMO时间,并发症和生存率的数据.
- 分析包括一个不包括溺水和外体吸收 (FBA) 的子队列.
主要成果:
- 包括55名儿童;整体存活率为69%.
- 幸存率因创伤类型而异,FBA,冷水溺水和呼吸道受伤显示100%的生存率.
- 虽然急性ECMO的生存率略低 (62%对68%),但在创伤伤害子队列中,这种差异并不显著 (p=0.53).
结论:
- 这项研究是使用当代数据对儿科创伤ECMO进行的最大的多中心分析.
- 儿科创伤ECMO的整体存活率与非创伤ECMO病例相比较.
- 对于患有FBA,冷水溺水和呼吸道受伤的儿科患者来说,ECMO提供了显著的生存益处.
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