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首页> 外文期刊>British Journal of Haematology >Extracorporeal membrane oxygenation as a rescue therapy for leukaemic children with pulmonary failure
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Extracorporeal membrane oxygenation as a rescue therapy for leukaemic children with pulmonary failure

机译：体外膜氧合作为白血病儿童肺衰竭的一种抢救疗法

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SummaryIn patients with leukaemia, acute respiratory distress syndrome (ARDS) secondary to intensified chemotherapy-induced immunosuppression is a devastating disorder resulting in high morbidity and mortality. Compared to standard indications for extracorporeal membrane oxygenation (ECMO), cytopenia further increases the risks of infection and bleeding. We describe the use of ECMO in four children with ARDS and leukaemia. Two patients (50%) survived, pulmonary function recovered and they are in prolonged first remission. The two other patients died from ARDS and pulmonary leukaemic infiltration. Although ECMO support is a high-risk setup for nosocomial infection we observed no additional septic episodes. All patients had a highly increased demand for packed platelet and red blood cell transfusions. This increased demand and unmanageable chronic bleeding into both lungs in one patient were probably caused by a combination of coagulopathy from the primary illness, the use of anticoagulants, chemotherapy-induced cytopenia, and a reduced survival rate of platelets and red cells due to permanent contact to foreign surface. We concluded that ECMO is a supportive tool to reduce the incidence of early death, treatment-related mortality and, ultimately, to improve overall survival in childhood leukaemia.
机译：总结在白血病患者中，继发于化学疗法诱导的免疫抑制作用增强的急性呼吸窘迫综合征（ARDS）是一种破坏性疾病，导致较高的发病率和死亡率。与体外膜氧合（ECMO）的标准适应症相比，血细胞减少症进一步增加了感染和出血的风险。我们描述了在四个ARDS和白血病儿童中使用ECMO。两名患者（50％）存活，肺功能恢复并且他们的首次缓解时间延长。另外两名患者死于ARDS和肺白细胞浸润。尽管ECMO支持是医院感染的高风险机构，但我们没有发现其他败血症发作。所有患者对包装血小板和红细胞输血的需求都大大增加。一名患者双肺肺部需求增加和难以控制的慢性出血可能是由于原发性疾病引起的凝血病，使用抗凝剂，化疗引起的血细胞减少以及永久性接触导致血小板和红细胞存活率降低所致到异物表面。我们得出的结论是，ECMO是减少早期死亡，与治疗相关的死亡率，并最终改善儿童白血病总体存活率的支持工具。

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