Short-term neurologic outcomes in pediatric extracorporeal membrane oxygenation are proportional to bleeding severity graded by a novel bleeding scale.

Autor:	Doane K; Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA., Guffey D; Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA., Loftis LL; Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA., Nguyen TC; Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA., Musick MA; Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA., Ruth A; Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA., Coleman RD; Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA., Teruya J; Departments of Pathology & Immunology, Pediatrics, and Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA., Allen C; Division of Pediatric Critical Care, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA., Bembea MM; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Boville B; Pediatric Critical Care Medicine Division, Helen DeVos Children's Hospital, Grand Rapids, MI, USA.; Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, USA., Furlong-Dillard J; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Norton Children's Hospital and University of Louisville School of Medicine, Louisville, KY, USA., Kaipa S; Department of Pediatrics, Children's Nebraska and University of Nebraska Medical Center, Omaha, NE, USA., Leimanis M; Pediatric Critical Care Medicine Division, Helen DeVos Children's Hospital, Grand Rapids, MI, USA.; Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, USA., Malone MP; Division of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA., Rasmussen LK; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA., Said A; Division of Pediatric Critical Care, Department of Pediatrics, Institute of Informatics, Data Science & Biostatistics (I2DB), Washington University in St. Louis School of Medicine, St. Louis, MO, USA., Steiner ME; Divisions of Hematology and Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA., Tzanetos DT; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Norton Children's Hospital and University of Louisville School of Medicine, Louisville, KY, USA., Viamonte H; Divisions of Cardiology and Critical Care, Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA., Wallenkamp L; Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA., Saini A; Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.
Jazyk:	angličtina
Zdroj:	Perfusion [Perfusion] 2024 Oct 18, pp. 2676591241293673. Date of Electronic Publication: 2024 Oct 18.
DOI:	10.1177/02676591241293673
Abstrakt:	Introduction: This study aimed to characterize the severity of bleeding and its association with short-term neurologic outcomes in pediatric ECMO. Methods: Multicenter retrospective cohort study of pediatric ECMO patients at 10 centers utilizing the Pediatric ECMO Outcomes Registry (PEDECOR) database from December 2013-February 2019. Subjects excluded were post-cardiac surgery patients and those with neonatal pathologies. A novel ECMO bleeding scale was utilized to categorize daily bleeding events. Poor short-term neurologic outcome was defined as an unfavorable Pediatric Cerebral Performance Category (PCPC) or Pediatric Overall Performance Category (POPC) (score of >3) at hospital discharge. Results: This study included 283 pediatric ECMO patients with a median (interquartile range [IQR]) age of 1.3 years [0.1, 9.0], ECMO duration of 5 days [3.0, 9.5], and 44.1% mortality. Unfavorable PCPC and POPC were observed in 48.4% and 51.3% of patients at discharge, respectively. Multivariable logistic regression analysis included patient's age, cannulation type, duration of ECMO, need for cardiopulmonary resuscitation, acute kidney injury, new infection, and vasoactive-inotropic score. As the severity of bleeding increased, there was a corresponding increase in the likelihood of poor neurologic recovery, shown by increasing odds of unfavorable neurologic outcome (PCPC), with an adjusted odds ratio (aOR) of 0.77 (confidence interval [CI] 0.36-1.62), 1.87 (0.54-6.45), 2.97 (1.32-6.69), and 5.56 (0.59-52.25) for increasing bleeding severity (grade 1 to 4 events, respectively). Similarly, unfavorable POPC aOR (CI) was 1.02 (0.48-2.17), 2.05 (0.63-6.70), 5.29 (2.12-13.23), and 5.11 (0.66-39.64) for bleeding grade 1 to 4 events. Conclusion: Short-term neurologic outcomes in pediatric ECMO are proportional to the severity of bleeding events. Strategies to mitigate bleeding events could improve neurologic recovery in pediatric ECMO. Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Jun Teruya: Evaheart member of DSMB and STAGO honoraria for presentation: Ahmed Said: supported by the Children’s Discovery Institute Faculty Development Award at Washington University in St. Louis: Marie Steiner: Teaching contract (managing coagulation) with Medtronic and study advisory board for Octapharma (AT in Adult CPB heparin resistance). All other authors report no conflicts of interest.
Databáze:	MEDLINE
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