Abstract：
OBJECTIVE: The aim of this study was to assess the early outcomes and risk factors of paediatric patients requiring extracorporeal membrane oxygenation after cardiac surgery (post-cardiotomy).
METHODS: Retrospective binational cohort study from the Australia and New Zealand Congenital Outcomes Registry for Surgery database. All patients younger than 18 years of age who underwent a paediatric cardiac surgical procedure from 1 January 2013 to 31 December 2021 and required post-cardiotomy extracorporeal membrane oxygenation (PC-ECMO) in the same hospital admission were included in the study.
RESULTS: Of the 12 290 patients included in the study, 376 patients required post-cardiotomy ECMO (3%). Amongst these patients, hospital mortality was 35.6% and two-thirds of patients experienced a major complication. Hypoplastic left heart syndrome was the most common diagnosis (17%). The Norwood procedure and modified Blalock-Taussig shunts had the highest incidence of requiring PC-ECMO (odds ratio of 10 and 6.8 respectively). Predictors of hospital mortality after PC-ECMO included single-ventricle physiology, intracranial haemorrhage and chylothorax.
CONCLUSIONS: In the current era, one-third of patients who required PC-ECMO after paediatric cardiac surgery in Australia and New Zealand did not survive to hospital discharge. The Norwood procedure and isolated modified Blalock-Taussig shunt had the highest incidence of requiring PC-ECMO. Patients undergoing the Norwood procedure had the highest mortality (48%). Two-thirds of patients on PC-ECMO developed a major complication.
METHODS: Retrospective binational cohort study from the Australia and New Zealand Congenital Outcomes Registry for Surgery database. All patients younger than 18 years of age who underwent a paediatric cardiac surgical procedure from 1 January 2013 to 31 December 2021 and required post-cardiotomy extracorporeal membrane oxygenation (PC-ECMO) in the same hospital admission were included in the study.
RESULTS: Of the 12 290 patients included in the study, 376 patients required post-cardiotomy ECMO (3%). Amongst these patients, hospital mortality was 35.6% and two-thirds of patients experienced a major complication. Hypoplastic left heart syndrome was the most common diagnosis (17%). The Norwood procedure and modified Blalock-Taussig shunts had the highest incidence of requiring PC-ECMO (odds ratio of 10 and 6.8 respectively). Predictors of hospital mortality after PC-ECMO included single-ventricle physiology, intracranial haemorrhage and chylothorax.
CONCLUSIONS: In the current era, one-third of patients who required PC-ECMO after paediatric cardiac surgery in Australia and New Zealand did not survive to hospital discharge. The Norwood procedure and isolated modified Blalock-Taussig shunt had the highest incidence of requiring PC-ECMO. Patients undergoing the Norwood procedure had the highest mortality (48%). Two-thirds of patients on PC-ECMO developed a major complication.
摘要：
目的：评估心脏手术（心脏切开术后）后需要体外膜氧合的儿科患者的早期结局和危险因素。
方法：来自澳大利亚和新西兰先天性手术结果注册数据库的回顾性双队列研究。所有年龄在18岁以下的患者在2013年1月1日至2021年12月31日期间接受了小儿心脏外科手术，并在同一住院期间需要进行心脏切开术后体外膜氧合的患者均纳入研究。
结果：在纳入研究的12,290名患者中，376例患者需要心脏切开术后体外膜氧合（3％）。在这些患者中，住院死亡率为35.6%,2/3的患者出现重大并发症.左心发育不良综合征是最常见的诊断（17％）。Norwood手术和改良的Blalock-Taussig分流术需要心脏切开术后体外膜氧合的发生率最高（比值比分别为10和6.8）。心脏切开术后体外膜氧合后医院死亡率的预测因素包括单心室生理，颅内出血和乳糜胸。
结论：在当前时代，在澳大利亚和新西兰,1/3的儿科心脏手术后需要PC-ECMO的患者未能存活至出院.Norwood手术和分离的改良Blalock-Taussig分流术需要PC-ECMO的发生率最高。接受诺伍德手术的患者死亡率最高(48%)。三分之二的PC-ECMO患者出现了严重的并发症。
方法：来自澳大利亚和新西兰先天性手术结果注册数据库的回顾性双队列研究。所有年龄在18岁以下的患者在2013年1月1日至2021年12月31日期间接受了小儿心脏外科手术，并在同一住院期间需要进行心脏切开术后体外膜氧合的患者均纳入研究。
结果：在纳入研究的12,290名患者中，376例患者需要心脏切开术后体外膜氧合（3％）。在这些患者中，住院死亡率为35.6%,2/3的患者出现重大并发症.左心发育不良综合征是最常见的诊断（17％）。Norwood手术和改良的Blalock-Taussig分流术需要心脏切开术后体外膜氧合的发生率最高（比值比分别为10和6.8）。心脏切开术后体外膜氧合后医院死亡率的预测因素包括单心室生理，颅内出血和乳糜胸。
结论：在当前时代，在澳大利亚和新西兰,1/3的儿科心脏手术后需要PC-ECMO的患者未能存活至出院.Norwood手术和分离的改良Blalock-Taussig分流术需要PC-ECMO的发生率最高。接受诺伍德手术的患者死亡率最高(48%)。三分之二的PC-ECMO患者出现了严重的并发症。
