| Autor: |
Yang X; Department of Critical Care Medicine, Children's Hospital of Fudan University, Shanghai 201102, China., Cheng Y; Department of Critical Care Medicine, Children's Hospital of Fudan University, Shanghai 201102, China., Hong XY; Department of Critical Care Medicine, Bayi Children's Hospital of Beijing Military General Hospital, Beijing 100010, China., Guo YX; Pediatric Intensive Care Unit, Guangdong Provincial People's Hospital, Guangzhou 519041, China., Wang X; Department of Pediatric Surgery, Fuwai Hospital of Chinese Academy of Medical Sciences, Beijing 100037, China., Yang YY; Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai 200127, China., Chu JP; Department of Critical Care Medicine, Xi'an Children's Hospital, Xi'an 710002, China., Jin YP; Pediatric Intensive Care Unit, Shandong Provincial Hospital, Jinan 250021, China., Cheng YB; Department of Critical Care Medicine, Henan Children's Hospital, Zhengzhou 451161, China., Zhang YC; Department of Critical Care Medicine, Children's Hospital of Shanghai,Shanghai 200062, China., Lu GP; Department of Critical Care Medicine, Children's Hospital of Fudan University, Shanghai 201102, China. |
| Abstrakt: |
Objectives: To investigate the current application status and implementation difficulties of extracorporeal cardiopulmonary resuscitation (ECPR) in children with sudden cardiac arrest. Methods: This cross-sectional survey was conducted in 35 hospitals. A Children's ECPR Information Questionnaire on the implementation status of ECPR technology (abbreviated as the questionnaire) was designed, to collect the data of 385 children treated with ECPR in the 35 hospitals. The survey extracted the information about development of ECPR, the maintenance of extracorporeal membrane oxygenation (ECMO) machine, the indication of ECPR, and the difficulties of implementation in China. These ECPR patients were grouped based on their age, the hospital location and level, to compare the survival rates after weaning and discharge. The statistical analysis used Chi-square test and one-way analysis of variance for the comparison between the groups, LSD method for post hoc testing, and Bonferroni method for pairwise comparison. Results: Of the 385 ECPR cases, 224 were males and 161 females. There were 185 (48.1%) survival cases after weaning and 157 (40.8%) after discharge. There were 324 children (84.2%) receiving ECPR for cardiac disease and 27 children (7.0%) for respiratory failure. The primary cause of death in ECPR patients was circulatory failure (82 cases, 35.9%), followed by brain failure (80 cases, 35.0%). The most common place of ECPR was intensive care unit (ICU) (278 cases, 72.2%); ECPR catheters were mostly inserted through incision (327 cases, 84.9%). There were 32 hospitals (91.4%) had established ECMO emergency teams, holding 125 ECMO machines in total. ECMO machines mainly located in ICU (89 pieces, 71.2%), and the majority of hospitals (32 units, 91.4%) did not have pre-charged loops. There were no statistically significant differences in the post-withdrawal and post-discharge survival rates of ECPR patients among different age groups, regions, and hospitals (all P >0.05). The top 5 difficulties in implementing ECPR in non-ICU environments were lack of ECMO machines (16 times), difficulty in placing CPR pipes (15 times), long time intervals between CPR and ECMO transfer (13 times), lack of conventional backup ECMO loops (10 times), and inability of ECMO emergency teams to quickly arrive at the site (5 times). Conclusion: ECPR has been gradually developed in the field of pediatric critical care in China, and needs to be further standardized. ECPR in non-ICU environment remains a challenge. |
