Li Xiangjie,Peng Wei.Application advances of extracorporeal membrane oxygenation in pediatric congenital heart disease surgery[J].Journal of Clinical Pediatric Surgery,2022,21(06):576-581.[doi:10.3760/cma.j.cn101785-202202042-015]
小儿先天性心脏病围手术期体外膜氧合技术的应用进展
- Title:
- Application advances of extracorporeal membrane oxygenation in pediatric congenital heart disease surgery
- 摘要:
- 随着机械循环支持(mechanical circulatory support,MCS)技术的发展,体外膜氧合(extracorporeal membrane oxygenation,ECMO)技术被作为机械循环支持的主要治疗手段,应用于心源性休克、低氧血症、呼吸衰竭、心肺复苏等紧急情况。近年来,ECMO技术在小儿先天性心脏病(congenital heart disease,CHD)围手术期的应用受到人们越来越多的关注,但也存在一定的局限性。本文概述ECMO技术在CHD患儿围手术期的应用进展,讨论ECMO技术应用于CHD患儿的适应证、禁忌证以及相关并发症与应对策略。
- Abstract:
- With a rapid technological development of mechanical circulatory support (MCS), extracorporeal membrane oxygenation (ECMO) has been applied for such emergencies as cardiogenic shock, hypoxemia, respiratory failure and cardiopulmonary resuscitation.In recent years, its application during perioperative period of pediatric congenital heart disease (CHD) has attracted widespread attention, along with some limitations and complications.This review summarized the application progress of ECMO technology during perioperative period and discussed its indications, contraindications, complications and coping strategies in CHD children.
参考文献/References:
[1] 刘成军, 卢思为.儿童体外膜肺氧合技术应用现状和前景[J].西部医学, 2020, 32(5):643-646.DOI:10.3969/j.issn.1672-3511.2020.05.005.Liu CJ, Lu SW.Application status and Prospect of extracorporeal membrane oxygenation in children[J].West Med, 2020, 32(5):643-646.DOI:10.3969/j.issn.1672-3511.2020.05.005.
[2] 闫钢风, 蔡小狄, 周成斌, 等.中国大陆地区儿童重症监护病房体外膜肺氧合应用现状的多中心调查[J].中华儿科杂志, 2018, 56(12):929-932.DOI:10.3760/cma.j.issn.0578-1310.2018.12.008.Yan GF, Cai XD, Zhou CB, et al.Multicenter survey of extracorporeal membrane oxygenation in pediatric intensive care unit in Chinese mainland[J].Chin J Pediatr, 2018, 56(12):929-932.DOI:10.3760/cma.j.issn.0578-1310.2018.12.008.
[3] Lorusso R, Raffa GM, Kowalewski M, et al.Structured review of post-cardiotomy extracorporeal membrane oxygenation:Part 2-pediatric patients[J].J Heart Lung Transplant, 2019, 38(11):1144-1161.DOI:10.1016/j.healun.2019.07.004.
[4] Howard TS, Kalish BT, Wigmore D, et al.Association of extracorporeal membrane oxygenation support adequacy and residual lesions with outcomes in neonates supported after cardiac surgery[J].Pediatr Crit Care Med, 2016, 17(11):1045-1054.DOI:10.1097/PCC.0000000000000943.
[5] 于新迪, 杨寅愉, 沈佳, 等.体外膜肺氧合在新生儿复杂先天性心脏病术后救治中的效果分析[J].中国体外循环杂志, 2018, 16(1):7-11.DOI:10.13498/j.cnki.chin.j.ecc.2018.01.03.Yu XD, Yang YY, Shen J, et al.Effect of extracorporeal membrane oxygenation on postoperative treatment of neonatal complex congenital heart disease[J].Chin Jcardiopulmonary Bypass, 2018, 16(1):7-11.DOI:10.13498/j.cnki.chin.j.ecc.2018.01.03.
[6] Van Ommen CH, Neunert CE, Chitlur MB.Neonatal ECMO[J].Front Med (Lausanne), 2018, 5:289.DOI:10.3389/fmed.2018.00289.
[7] Erdil T, Lemme F, Konetzka A, et al.Extracorporeal membrane oxygenation support in pediatrics[J].Ann Cardiothorac Surg, 2019, 8(1):109-115.DOI:10.21037/acs.2018.09.08.
[8] Slooff V, Hoogendoorn R, Nielsen J, et al.Role of extracorporeal membrane oxygenation in pediatric cancer patients:a systematic review and meta-analysis of observational studies[J].Ann Intensive Care, 2022, 12(1):8.DOI:10.1186/s13613-022-00983-0.
[9] Wang Z, Zhang F, Xiang L, et al.Successful use of extracorporeal life support and continuous renal replacement therapy in the treatment of cardiogenic shock induced by tumor lysis syndrome in a pediatric patient with lymphoma:a case report[J].Front Med (Lausanne), 2021, 8:762788.DOI:10.3389/fmed.2021.762788.
[10] Martin A, Rycus PT, Farooqi A, et al.Extracorporeal membrane oxygenation outcomes in children with Williams syndrome:a review of the ELSO registry[J].Perfusion, 2022, 37(4):359-366.DOI:10.1177/0267659121999299.
[11] Etchill EW, Dante SA, Garcia AV.Extracorporeal membrane oxygenation in the pediatric population-who should go on, and who should not[J].Curr Opin Pediatr, 2020, 32(3):416-423.DOI:10.1097/MOP.0000000000000904.
[12] 李淑涓, 蒋思远, 曹云, 等.新生儿体外膜肺氧合相关神经系统损伤研究进展[J].中华儿科杂志, 2021, 59(10):889-892.DOI:10.3760/cma.j.cn112140-20210416-00323.Li SJ, Jiang SY, Cao Y, et al.Research advances in neurologic complications in neonates supported with extracorporeal membrane oxygenation[J].Chin J Pediatr, 2021, 59(10):889-892.DOI:10.3760/cma.j.cn112140-20210416-00323.
[13] Wang L, Yang F, Zhang S, et al.Percutaneous versus surgical cannulation for femoro-femoral VA-ECMO in patients with cardiogenic shock:Results from the Extracorporeal Life Support Organization Registry[J].J Heart Lung Transplant, 2022, 41(4):470-481.DOI:10.1016/j.healun.2022.01.009.
[14] 应力阳, 齐建川, 刘喜旺, 等.颈部插管在重症患儿体外膜肺氧合治疗中的应用价值[J].临床小儿外科杂志, 2020, 19(10):926-929.DOI:10.3969/j.issn.1671-6353.2020.10.012.Ying LY, Qi JC, Liu XW, et al.Application of cervical intubation for severe diseases by extracorporeal membrane oxygenation in children[J].J Clin Pediatr Surg, 2020, 19(10):926-929.DOI:10.3969/j.issn.1671-6353.2020.10.012.
[15] Johnson K, Jarboe MD, Mychaliska GB, et al.Is there a best approach for extracorporeal life support cannulation:a review of the extracorporeal life support organization[J].J Pediatr Surg, 2018, 53(7):1301-1304.DOI:10.1016/j.jpedsurg.2018.01.015.
[16] 丁培成, 莫绪明, 彭卫, 等.体外膜氧合在先天性心脏病儿童危急重症中的应用[J].中国体外循环杂志, 2021, 19(4):195-200.DOI:10.13498/j.cnki.chin.j.ecc.2021.04.02.Ding PC, Mo XM, Peng W, et al.Application of extracorporeal membrane oxygenation in critical children with congenital heart disease[J].Chin J Cardiopulmonary Bypass, 2021, 19(4):195-200.DOI:10.13498/j.cnki.chin.j.ecc.2021.04.02.
[17] Brown G, Moynihan KM, Deatrick KB, et al.Extracorporeal life support organization (ELSO):guidelines for pediatric cardiac failure[J].ASAIO J, 2021, 67(5):463-475.DOI:10.1097/MAT.0000000000001431.
[18] Polito A, Dupuis-Lozeron E, Barbaro R, et al.Ventilation parameters before extracorporeal membrane oxygenator and in-hospital mortality in children:a review of the ELSO registry[J].ASAIO J, 2022, 68(2):281-286.DOI:10.1097/MAT.0000000000001445.
[19] Friedman ML, Barbaro RP, Bembea MM, et al.Mechanical ventilation in children on venovenous ECMO[J].Respir Care, 2020, 65(3):271-280.DOI:10.4187/respcare.07214.
[20] Di Nardo M, Stoppa F, David P, et al.Reversed differential cyanosis during veno-arterial extracorporeal membrane oxygenation in infants:the reevaluation of an old phenomenon[J].Eur J Heart Fail, 2017, 19(Suppl 2):117-119.DOI:10.1002/ejhf.855.
[21] Schiller RM, Tibboel D.Neurocognitive outcome after treatment with(out) ECMO for neonatal critical respiratory or cardiac failure[J].Front Pediatr, 2019, 7:494.DOI:10.3389/fped.2019.00494.
[22] Madderom MJ, Schiller RM, Gischler SJ, et al.Growing up after critical illness:verbal, visual-spatial, and working memory problems in neonatal extracorporeal membrane oxygenation survivors[J].Crit Care Med, 2016, 44(6):1182-1190.DOI:10.1097/CCM.0000000000001626.
[23] Liao MT, Tsai IJ, Lin FH, et al.Risk factors for in-hospital mortality and acute kidney injury in neonatal-pediatric patients receiving extracorporeal membrane oxygenation[J].J Formos Med Assoc, 2021, 120(9):1758-1767.DOI:10.1016/j.jfma.2021.03.004.
[24] 庞亚昌, 徐卓明, 张明杰, 等.腹膜透析在小儿先天性心脏病手术后的应用[J].临床小儿外科杂志, 2021, 20(8):743-748.DOI:10.12260/lcxewkzz.2021.08.008.Pang YC, Xu ZM, Zhang MJ, et al.Application and effect of peritoneal dialysis in children after congenital heart surgery[J].J Clin Pediatr Surg, 2021, 20(8):743-748.DOI:10.12260/lcxewkzz.2021.08.008.
[25] 束亚琴, 莫绪明, 彭卫, 等.肾替代治疗联合ECMO在先天性心脏病术后的应用研究[J].中华小儿外科杂志, 2021, 42(8):688-694.DOI:10.3760/cma.j.cn421158-20210419-00195.Shu YQ, Mo XM, Peng W, et al.Application of ECMO in pediatric cardiovascular surgery renal replacement therapy plus extracorporeal membrane oxygenation after cardiac surgery in children[J].Chin J Pediatr Surg, 2021, 42(8):688-694.DOI:10.3760/cma.j.cn421158-20210419-00195.
[26] Cortina G, McRae R, Hoq M, et al.Mortality of critically ill children requiring continuous renal replacement therapy:effect of fluid overload, underlying disease, and timing of initiation[J].Pediatr Crit Care Med, 2019, 20(4):314-322.DOI:10.1097/PCC.0000000000001806.
[27] Murphy HJ, Gien J, Sahay R, et al.Acute kidney injury, fluid overload, and renal replacement therapy differ by underlying diagnosis in neonatal extracorporeal support and impact mortality disparately[J].Blood Purif, 2021, 50(6):808-817.DOI:10.1159/000512538.
[28] Gorga SM, Lima L, Askenazi DJ, et al.Fluid balance management informs renal replacement therapy use during pediatric extracorporeal membrane oxygenation:a survey report from the kidney intervention during extracorporeal membrane oxygenation group[J].ASAIO J, 2022, 68(3):407-412.DOI:10.1097/MAT.0000000000001471.
[29] Dong J, Feng T, Thapa-Chhetry B, et al.Machine learning model for early prediction of acute kidney injury (AKI) in pediatric critical care[J].Crit Care, 2021, 25(1):288.DOI:10.1186/s13054-021-03724-0.
[30] Kanji R, Vandenbriele C, Arachchillage DRJ, et al.Optimal tests to minimise bleeding and ischaemic complications in patients on extracorporeal membrane oxygenation[J].Thromb Haemost, 2021.DOI:10.1055/a-1508-8230.
[31] 曾子桓, 崔云.儿童体外膜肺氧合支持下的心肺复苏进展[J].中华儿科杂志, 2018, 56(9):709-712.DOI:10.3760/cma.j.issn.0578-1310.2018.09.018.Zeng ZH, Cui Y.Recent advances of cardiopulmonary resuscitation supported by extracorporeal membrane oxygenation in children[J].Chin J Pediatr, 2018, 56(9):709-712.DOI:10.3760/cma.j.issn.0578-1310.2018.09.018.
[32] Bembea MM, Annich G, Rycus P, et al.Variability in anticoagulation management of patients on extracorporeal membrane oxygenation:an international survey[J].Pediatr Crit Care Med, 2013, 14(2):e77-e84.DOI:10.1097/PCC.0b013e31827127e4.
[33] Chlebowski MM, Baltagi S, Carlson M, et al.Clinical controversies in anticoagulation monitoring and antithrombin supplementation for ECMO[J].Crit Care, 2020, 24(1):19.DOI:10.1186/s13054-020-2726-9.
[34] Giorni C, Rizza A, Favia I, et al.Pediatric mechanical circulatory support:pathophysiology of pediatric hemostasis and available options[J].Front Cardiovasc Med, 2021, 8:671241.DOI:10.3389/fcvm.2021.671241.
[35] Hensch LA, Hui SR, Teruya J.Coagulation and bleeding management in pediatric extracorporeal membrane oxygenation:clinical scenarios and review[J].Front Med (Lausanne), 2018, 5:361.DOI:10.3389/fmed.2018.00361.
[36] Barton R, Ignjatovic V, Monagle P.Anticoagulation during ECMO in neonatal and paediatric patients[J].Thromb Res, 2019, 173:172-177.DOI:10.1016/j.thromres.2018.05.009.
[37] Rabinowitz EJ, Ouyang A, Armstrong DR, et al.Poor reliability of common measures of anticoagulation in pediatric extracorporeal membrane oxygenation[J].ASAIO J, 2021.DOI:10.1097/MAT.0000000000001582.
[38] Nellis ME, Vasovic LV, Goel R, et al.Epidemiology of the use of hemostatic agents in children supported by extracorporeal membrane oxygenation:a pediatric health information system database study[J].Front Pediatr, 2021, 9:673613.DOI:10.3389/fped.2021.673613.
[39] Jin Y, Feng Z, Zhao J, et al.Outcomes and factors associated with early mortality in pediatric postcardiotomy veno-arterial extracorporeal membrane oxygenation[J].Artif Organs, 2021, 45(1):6-14.DOI:10.1111/aor.13773.
[40] Surti J, Jain I, Mishra A, et al.Venoarterial extra corporeal membrane oxygenation and blood component usage in pediatric patients undergoing cardiac surgery:Single centre experience[J].Ann Card Anaesth, 2021, 24(2):203-208.DOI:10.4103/aca.ACA_112_19.
[41] Fallon BP, Gadepalli SK, Hirschl RB.Pediatric and neonatal extracorporeal life support:current state and continuing evolution[J].Pediatr Surg Int, 2021, 37(1):17-35.DOI:10.1007/s00383-020-04800-2.
[42] Chen GL, Qiao YR, Ma JH, et al.Extracorporeal cardiopulmonary resuscitation in children of Asia Pacific:a retrospective analysis of extracorporeal life support organization registry[J].Chin Med J (Engl), 2018, 131(12):1436-1443.DOI:10.4103/0366-6999.233946.
[43] 莫绪明, 邹靓.中国小儿心脏病ECMO应用现状及存在的问题[J].中华小儿外科杂志, 2021, 42(8):673-678.DOI:10.3760/cma.j.cn421158-20210421-00201.Mo XM, Zou L.Current applications and existing problems of ECMO for pediatric heart diseases in China[J].Chin J Pediatr Surg, 2021, 42(8):673-678.DOI:10.3760/cma.j.cn421158-20210421-00201.
[44] Moynihan KM, Purol N, Alexander P, et al.A communication guide for pediatric extracorporeal membrane oxygenation[J].Pediatr Crit Care Med, 2021, 22(9):832-841.DOI:10.1097/PCC.0000000000002758.
相似文献/References:
[1]常绘文,沈振亚.右腋下小切口在儿童心内手术中的应用[J].临床小儿外科杂志,2010,9(06):439.
[2]丁晋阳 莫绪明 顾海涛 孙剑 彭卫 戚继荣 沈立 束亚琴 钱龙宝. 延迟关胸技术在婴儿复杂危重先心病手术中的应用[J].临床小儿外科杂志,2011,10(02):98.
DING Jin yang,MO Xu ming,GU Hai tao,et al. Delayed Sternal Closure following operations for complex and severe congenital heart disease in infant[J].Journal of Clinical Pediatric Surgery,2011,10(06):98.
[3]仇杰 费忠化 刘宏生. 婴幼儿先心病术后并发纵膈气肿临床分析[J].临床小儿外科杂志,2012,11(04):260.
[J].Journal of Clinical Pediatric Surgery,2012,11(06):260.
[4]杨丽君 林茹 叶莉芬. 小儿先天性心脏病手术中残余机血洗涤回输对凝血功能的影响[J].临床小儿外科杂志,2012,11(06):409.
[J].Journal of Clinical Pediatric Surgery,2012,11(06):409.
[5]孙剑 莫绪明 钱龙宝. 儿童先心病手术后胸骨-纵隔感染的预防和治疗[J].临床小儿外科杂志,2013,12(05):395.
[6]郭健 李晓峰 刘晖. 先心病手术后植入永久起搏器治疗房室传导阻滞[J].临床小儿外科杂志,2014,13(03):188.
[7]陈仁伟 罗金文 曾德斌. 右腋下小切口在小儿心内直视手术中的应用研究[J].临床小儿外科杂志,2014,13(03):214.
[8]沈华 宓亚平 贾兵. 小婴儿心内直视术后撤离呼吸机失败相关因素分析[J].临床小儿外科杂志,2015,14(02):117.
[9]高毅,艾宇航..小儿先心病术后机械通气时间延长的多因素分析及治疗策略[J].临床小儿外科杂志,2016,15(05):481.
[10]田慧,董丽娜,李成龙,等.AsirV联合“双低”扫描技术在儿童先天性心脏病诊断中的应用[J].临床小儿外科杂志,2016,15(05):494.
备注/Memo
收稿日期:2022-02-21。
基金项目:南京市卫生科技发展项目(YKK20118)
通讯作者:彭卫,Email:pwking@sina.com