体外膜肺氧合辅助心肺复苏治疗心搏骤停17例分析

Analysis of extracorporeal membrane oxygenation assisted cardiopulmonary resuscitation in treatment of 17 cases with cardiac arrest

目的探讨快速体外膜肺氧合（ECMO）辅助心肺复苏（CPR）在救治心搏骤停危重患儿中的临床应用。方法回顾性分析2012年6月至2015年12月在南方医科大学陆军总医院临床医学院附属八一儿童医院因心搏骤停接受ECMO辅助CPR治疗的重症患儿的临床资料，并采用SPSS 20.0软件进行统计学分析。结果共17例患儿接受ECMO辅助CPR治疗，男13例，女4例；年龄5 h～5岁；体质量3～16 kg；存活5例，存活率29.41%；死亡12例，病死率70.59%，其中5例因无法撤离ECMO死亡，7例撤离ECMO后死于并发症。其中年龄、性别比、体质量等人口统计学资料2组比较差异均无统计学意义（均P〉0.05）。2组原发疾病类型比较差异无统计学意义（P〉0.05）。2组患儿CPR时间和ECMO支持时间比较差异均无统计学意义（t=1.541、0.375，均P〉0.05）。共11例患儿出现ECMO相关并发症，发生率为64.71%，存活组并发症发生率明显低于死亡组（χ^2=8.709，P=0.003），常见的并发症为出血、肢端坏死、感染、多器官衰竭、神经系统损伤和急性肾损害。开始ECMO支持时，存活组与死亡组乳酸水平比较差异无统计学意义（P〉0.05），但在ECMO支持后24 h，存活组乳酸水平显著低于死亡组（t=2.896，P=0.014）。结论ECMO辅助CPR可提高常规CPR无反应的心搏骤停危重患儿的存活率。ECMO支持后24 h血清乳酸水平对预后评估有指导意义，ECMO患儿并发症仍是影响ECMO辅助CPR患儿预后的最重要因素。

ObjectiveTo explore the clinical application of extracorporeal membrane oxygenation （ECMO） assisted cardiopulmonary resuscitation（CPR）in the treatment of critically ill children with cardiac arrest.MethodsThe clinical data of critically ill children due to cardiac arrest who were treated with ECMO assisted CPR from June 2012 to December 2015 in Affiliated Bayi Children′s Hospital, Clinical Medical College in Army General Hospital, Southern Medical University were retrospectively reviewed, and the datas were analyzed by SPSS 20.0 software. ResultsA total of 17 patients received ECMO assisted CPR treatment, 13 cases were male, 4 cases were female, aged from 5 hours to 5 years old, the weight ranged from 3 to 16 kg; 5 cases survived, and the survival rate 29.41%; 12 cases died, the mortality rate 70.59%, of which 5 cases died of hear failure in withdrawal of ECMO, and 7 cases died of complications after withdrawal of ECMO.The age, sex ratio, body weight and other demographic data between 2 groups were not statistically significant （all P〉0.05）. There was no significant difference in the primary diseases between 2 groups （P〉0.05）. There was no significant difference in CPR time and ECMO support time between 2 groups （t=1.541, 0.375, all P〉0.05）. Among 11 cases of children with ECMO-related complications, the incidence rate was 64.71%, the incidence of complication in the survival group was significantly less than that in the death group （χ^2=8.709, P=0.003）. The common complications of ECMO were bleeding, acral necrosis, infection, multiple organ failure, nervous system injury and acute kidney injury.There was no significant difference in the level of lactic acid between the survival group and the death group （P〉0.05）before ECMO support started, but after 24 h of ECMO support, the lactic acid level in the survival group was significantly lower than that in the death group （t=2.896, P=0.014）.ConclusionsECMO assisted CPR can improve the survival rate of critically ill children who have cardiac arrest and have no response to the conventional CPR.The serum lactic acid level after 24 h ECMO support has a guiding significance for the prognosis assessment, and ECMO patients′ complications are still the most important factor affecting the prognosis of ECMO assisted CPR patients.