[Analysis of risk factors of central nervous system complications supported on extracorporeal membrane oxygenation]

Zhonghua Er Ke Za Zhi. 2022 Oct 2;60(10):1059-1065. doi: 10.3760/cma.j.cn112140-20220311-00191.
[Article in Chinese]

Abstract

Objective: To investigate the risk factors of central nervous system (CNS) complications in children undergoing extracorporeal membrane oxygenation (ECMO) support. Methods: The clinical data, ECMO parameters, laboratory examination and outcome (follow-up to 90 d after discharge) of 82 children treated with ECMO in the pediatric intensive care unit (PICU) of Shanghai Children's Hospital from December 2015 to December 2021 were analyzed retrospectively in this study. The patients were divided into CNS complication group and non-CNS complication group. The ECMO mode, ECMO catheterization mode, clinical and laboratory indicators pre-ECMO and 24 h after ECMO initiation, in-hospital mortality and 90-day mortality were compared with Chi-square test, t test and nonparametric rank sum test. Kaplan-Meier method was used to draw survival curve, and Log-rank test was used to compare the difference in survival rate. The receiver operating characteristic (ROC) curve was used to evaluate the power of variables to predict CNS complications. Results: A total of 82 children were treated with ECMO, including 49 males and 33 females, aged 34 (8, 80) months. There were 18 cases suffering CNS complications, including cerebral hemorrhage in 8 cases, epilepsy in 6 cases, simple cerebral infarction in 3 cases, and cerebral hemorrhage combined with cerebral infarction in 1 case. Veno-arterial ECMO accounted for a greater proportion in CNS complication group (17/18 vs. 67% (43/64), χ2=4.02, P=0.045). A higher percentage of children with CNS complications underwent surgical cannulation compared to those in non-CNS complication group (16/18 vs. 53% (34/64), χ2=7.55, P=0.006). The laboratory results indicated that lower pre-ECMO pH value (7.24 (7.15, 7.28) vs. 7.35 (7.26, 7.45), Z=-3.65, P<0.001) and platelet count 24 h after ECMO initiation (66 (27, 135) ×109/L vs. 107 (61, 157) ×109/L, Z=-2.04, P=0.041) were associated with CNS complications. In the CNS complication group, 7 children died during hospitalization and 7 died during 90-day after admission, and there was no significant difference compared with those in the non-CNS complication group (7/18 vs. 31% (20/64), 7/18 vs. 34% (22/64), both P>0.05). The ROC curve analysis indicated that the area under the ROC curve for pre-ECMO pH value was 0.738 (95%CI 0.598-0.877), and the optimal cut-off value was 7.325. Conclusions: CNS complications in children undergoing ECMO support are common. Pre-ECMO pH value <7.325 is a risk factor for CNS complications. Reducing the veno-arterial ECMO and surgical cannulation can help reduce the occurrence of CNS complications.

目的: 探讨体外膜氧合(ECMO)治疗患儿发生中枢神经系统(CNS)并发症的危险因素。 方法: 回顾性分析2015年12月至2021年12月上海市儿童医院重症医学科接受ECMO治疗82例患儿的一般情况、ECMO参数、实验室检查和随访(截至出院后90 d)等。根据有无CNS并发症分为CNS并发症组和无CNS并发症组,比较两组ECMO模式、置管方式,ECMO启动前及启动24 h后临床与实验室指标、住院病死率及90 d病死率等。组间比较采用χ2检验、t检验或非参数秩和检验,采用Kaplan-Meier法绘制生存曲线,Log-rank检验进行生存率的分析,绘制受试者工作特征(ROC)曲线评估相关临床参数对ECMO治疗患儿发生CNS并发症的预测价值。 结果: 82例患儿中,男49例、女33例,年龄34(8,80)月龄。ECMO支持患儿中18例(22%)发生CNS并发症,其中单纯脑出血8例、癫痫发作6例、单纯脑梗死3例、脑出血合并脑梗死1例。CNS并发症组中静-动脉ECMO患儿比例更高[17/18 比67%(43/64),χ2=4.02,P=0.045],手术切开置管患儿比例更高[16/18比53%(34/64),χ2=7.55,P=0.006]。监测ECMO启动前与启动24 h后指标,CNS并发症组ECMO启动前pH值较低[7.24(7.15,7.28)比7.35(7.26,7.45),Z=-3.65,P<0.001],启动24 h后血小板计数低[66(27,135)×109/L比 107(61,157)×109/L,Z=-2.04,P=0.041]。CNS并发症组住院死亡人数与90 d死亡人数均为7例,与无CNS并发症组差异均无统计学意义[7/18比31%(20/64),7/18比34%(22/64),均P>0.05]。ROC曲线分析显示,启动前pH值预测ECMO患儿发生CNS并发症的曲线下面积为0.738(95%CI 0.598~0.877),最佳截断值为7.325。 结论: ECMO治疗患儿CNS并发症发生率较高,启动前pH值<7.325是发生CNS并发症的危险因素,减少静-动脉ECMO模式及切开置管有助于减少CNS并发症的发生。.

MeSH terms

  • Central Nervous System
  • Cerebral Hemorrhage
  • Cerebral Infarction
  • Child
  • China / epidemiology
  • Extracorporeal Membrane Oxygenation* / adverse effects
  • Female
  • Humans
  • Male
  • Prognosis
  • Retrospective Studies
  • Risk Factors