Delayed institution of extracorporeal membrane oxygenation is associated with increased mortality rate and prolonged hospital stay

被引:28
作者
Gill, BS
Neville, HL
Khan, AM
Cox, CS
Lally, KP
机构
[1] Univ Texas, Houston Med Sch, Dept Surg, Houston, TX USA
[2] Univ Texas, Houston Med Sch, Dept Pediat, Houston, TX USA
[3] Mem Hermann Childrens Hosp, Houston, TX USA
关键词
meconium aspiration; extracorporeal membrane oxygenation; lung injury; mechanical ventilation;
D O I
10.1053/jpsu.2002.29417
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background/Purpose: Severe meconium aspiration syndrome (MAS) is a frequent indication for extracorporeal membrane oxygenation (ECMO). Trials of less invasive cardiopulmonary support may result in fewer infants treated with ECMO but could delay institution of ECMO. The authors hypothesized that those infants with severe MAS who are treated with ECMO early will have a lower mortality rate and a shorter hospital course than those who receive delayed ECMO, Methods: A retrospective review of all patients with MAS in the national extracorporeal life support (ELSO) registry for the decade 1989 through 1998 was performed. Data from the ELSO registry were examined for demographics, clinical parameters, and treatment course. Patients were divided into 3 groups based on the time from birth to institution of ECMO: group 1, 0 to 23 hours; group 2, 24 to 96 hours; and group 3, greater than 96 hours. These groups were compared for survival, duration of extracorporeal support, and duration of ventilatory support after ECMO. Statistical relevance was determined by analysis of variance (ANOVA) and Tukey's post-hoc test. Results: A total of 3,235 of 4,002 patients with MAS had complete information on duration of mechanical ventilation. Overall mortality rate was 5.8%. The mortality rate in group 1 (n = 1,266) was 4.8%, group 2 (n = 1,568) 6.0%, and group 3 (n = 401) 7.7%. An increased time to ECMO was associated with a significant increase in mortality rate (P <.05). This also was associated with significant increases in the length of the ECMO run (157 +/- 4 v 130 +/- 2 hours, P = .02) and duration of post-ECMO ventilation (157 +/- 17 v 118 +/- 3 hours; P <.001). Those patients in groups 1 and 2 who did not respond to a trial of high-frequency oscillatory ventilation had significantly longer ECMO runs (129 +/- 2 v 113 +/- 1 hours; P =.001) and longer post-ECMO ventilator courses (137 +/- 2 v 114 +/- 1 hours; P =.002) than those who did not. Conclusions: Delay in institution of Ecmo for MAS results in prolonged ECMO and need for post-ECMO ventilation. Consideration should be given to instituting ECMO earlier in patients with severe MAS. J Pediatr Surg 37:7-10. Copyright (C) 2002 by W.B. Saunders Company.
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页码:7 / 10
页数:4
相关论文
共 13 条
[1]   Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. [J].
Clark, RH ;
Kueser, TJ ;
Walker, MW ;
Southgate, WM ;
Huckaby, JL ;
Perez, JA ;
Roy, BJ ;
Keszler, M ;
Kinsella, JP .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (07) :469-474
[2]   TECHNICAL ASPECTS IN THE MANAGEMENT OF THE MECONIUM ASPIRATION SYNDROME WITH EXTRACORPOREAL-CIRCULATION [J].
GERMAN, JC ;
WORCESTER, C ;
GAZZANIGA, AB ;
HUXTABLE, RF ;
AMLIE, RN ;
BRAHMBHATT, N ;
BARTLETT, RH .
JOURNAL OF PEDIATRIC SURGERY, 1980, 15 (04) :378-383
[3]   Positive end-expiratory pressure and response to inhaled nitric oxide: Changing nonresponders to responders [J].
Johannigman, JA ;
Davis, K ;
Campbell, RS ;
Luchette, FA ;
Frame, SB ;
Branson, RD .
SURGERY, 2000, 127 (04) :390-394
[4]   Randomized, multicenter trial of inhaled nitric oxide and high-frequency oscillatory ventilation in severe, persistent pulmonary hypertension of the newborn [J].
Kinsella, JP ;
Truog, WE ;
Walsh, WF ;
Goldberg, RN ;
Bancalari, E ;
Mayock, DE ;
Redding, GJ ;
deLemos, RA ;
Sardesai, S ;
McCurnin, DC ;
Moreland, SG ;
Cutter, GR ;
Abman, SH .
JOURNAL OF PEDIATRICS, 1997, 131 (01) :55-62
[5]  
KOLOBOW T, 1987, AM REV RESPIR DIS, V135, P312
[6]   The effect of pre-ECLS ventilation time on survival and respiratory morbidity in the neonatal population [J].
Lewis, DA ;
Gauger, P ;
Delosh, TN ;
Dechert, RE ;
Hirschl, RB .
JOURNAL OF PEDIATRIC SURGERY, 1996, 31 (08) :1110-1114
[7]  
PARANKA MMS, 1995, PEDIATRICS, V95, P400
[8]   Mortality is directly related to the duration of mechanical ventilation before the initiation of extracorporeal life support for severe respiratory failure [J].
Pranikoff, T ;
Hirschl, RB ;
Steimle, CN ;
Anderson, HL ;
Bartlett, RH .
CRITICAL CARE MEDICINE, 1997, 25 (01) :28-32
[9]   The changing demographics of neonatal extracorporeal membrane oxygenation patients reported to the extracorporeal life support organization (ELSO) registry [J].
Roy, BJ ;
Rycus, P ;
Conrad, SA ;
Clark, RH .
PEDIATRICS, 2000, 106 (06) :1334-1338
[10]  
Schumacher R E, 1993, ASAIO J, V39, P873, DOI 10.1097/00002480-199310000-00010