Background: Recent advances in extracorporeal membrane oxygenation (ECMO) have led to increasing interest in its use during cardiopulmonary resuscitation (CPR). However, decisions regarding extracorporeal CPR (ECPR) in children are difficult as a result of limited studies, especially in Asia Pacific. The objective of this study was to investigate trends in survival and demographic details for children with ECPR in Asia Pacific recorded in the Extracorporeal Life Support Organization (ELSO) registry from 1999 to 2016 and identify the risk factors associated with in-hospital mortality.
Methods: The data of children younger than 18 years of age who received ECPR over the past 18 years in Asia Pacific were retrospectively analyzed. The data were extracted from the ELSO registry and divided into two 9-year groups (Group 1: 1999-2007 and Group 2: 2008-2016) to assess temporal changes using univariate analysis. Then, univariate and multiple logistic regression analyses were performed between survivors and nonsurvivors to identify factors independently associated with in-hospital mortality.
Results: A total of 321 children were included in final analysis, with an overall survival rate of 50.8%. Although survival rates were similar between Group 1 and Group 2 (43.1% vs. 52.5%, χ2 = 1.67, P = 0.196), the median age (1.7 [0.3, 19.2] months for Group 1 vs. 5.6 [0.8, 64.9] months for Group 2, t = -2.93, P = 0.003) and weight (3.7 [3.0, 11.5] kg for Group 1 vs. 6.0 [3.4, 20.3] kg for Group 2, t = -3.14, P = 0.002) of children increased over time, while the proportion of congenital heart disease (75.9% for Group 1 vs. 57.8% for Group 2, χ2 = 6.52, P = 0.011) and cardiogenic shock (36.2% for Group 1 vs. 7.2% for Group 2, χ2 = 36.59, P < 0.001) decreased. Patient conditions before ECMO were worse, while ECMO complications decreased across time periods, especially renal complications. Multiple logistic regression analysis of ECMO complications showed that disseminated intravascular coagulation (DIC), myocardial stunning, and neurological complications were independently associated with increased odds of hospital mortality.
Conclusions: The broader indications and decreased complication rates make EPCR to be applicated more and more extensive in children in Asia Pacific region. ECMO complications such as myocardial stunning are independently associated with decreased survival.
亚太地区儿童体外心肺复苏:对体外生命支持组织登记数据的回顾性分析摘要背景：随着体外膜氧合技术（ECMO）的不断发展，其在心肺复苏过程中的应用正引起越来越广泛的关注。本研究的目的在于回顾性分析1999-2016年国际体外生命支持组织（ELSO）亚太地区儿童体外心肺复苏（ECPR）的登记数据，对其发展趋势进行描述并探讨影响ECPR患儿生存的独立危险因素。 方法：本研究回顾性分析了1999年1月至2016年12月期间在亚太地区接受ECPR治疗且年龄小于18岁的儿童患者的登记数据，信息来源于ELSO组织。患者首先按接受ECPR治疗的时间分成两组（第1组：1999-2007年；第2组：2008-2016年），比较两组患者的基线资料，ECMO支持前信息，ECMO支持期间信息，ECMO相关并发症等资料。随后，将患者按临床结局分为存活组及死亡组，比较其相关信息，并应用单元和多元logistic回归分析探索影响ECPR患儿生存的独立危险因素。 结果：共有321名患儿纳入本研究，总生存率为50.8%。尽管第1组及第2组患儿存活率相似（43.1% vs. 52.5%, χ2 = 1.67, P=0.196），但第2组患儿的平均年龄 (第1组：1.7 [0.3, 19.2]月vs. 第2组：5.6 [0.8, 64.9] 月, t=−2.93, P=0.003) 及体重 (第1组：3.7 [3.0, 11.5] kg vs. 第2组：6.0 [3.4, 20.3] kg, t=−3.14, P=0.002)均高于第1组，且先天性心脏病（第1组：75.9% vs. 第2组：57.8%, χ2 = 6.52, P=0.011）及心源性休克（第1组：36.2% vs. 第2组：7.2%, χ2 = 36.59, P＜0.001）占比更低。相较第1组，第2组患儿ECMO支持期间并发症的发生率有所下降，尤其是肾脏相关并发症。多元logistic回归分显示ECMO相关并发症中，弥散性血管内凝血（DIC）、心肌顿抑及神经系统并发症是影响ECPR患儿生存的独立危险因素。 结论：ECPR治疗可以改善心脏骤停患儿的存活率，其适应症越来越广，并发症越来越少。ECMO相关并发症，如超声证实的心肌顿抑是影响ECPR患儿生存的独立危险因素。.
Keywords: Children; Extracorporeal Cardiopulmonary Resuscitation; Extracorporeal Life Support Organization; Extracorporeal Membrane Oxygenation.