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Initial Clinical Experiences With Novel Diagonal ECLS System in Pediatric Cardiac Patients

机译：小儿心脏病患者新型对角线ECL系统的初步临床经验

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Extracorporeal life support (ECLS) provides mechanical support following cardiac surgery when respiratory or cardiac failure occurs. The aim of this study was to analyze the safety and feasibility of the Medos Deltastream diagonal pump (DP3) ECLS system in pediatric cardiac patients. We described the technical considerations and risk factors related to the survival outcomes in 102 pediatric cardiac patients who received ECLS support between March 2011 and April 2016. We switched from the DP2 system, which was used for the initial 25 patients, to the DP3 system after November 2012. The DP3 was then used in a consecutive series of 77 patients (4.5% of all pediatric patients who underwent congenital heart surgery during the same time period). The patients' median age was 90 days (range: 2 days-12 years), while their median weight was 4 kg (range: 2.1-40 kg). Fifty four patients (70%) were weaned off ECLS, while 28 patients (36.3%) were successfully discharged from the hospital by means of the DP3 system. The median ECLS duration for survivors was 8.2 days (range: 4-14.5 days). The ECLS indications, durations, and initiation times had no statistical significance in terms of survival. Renal, hemorrhagic, and neurologic complications were all associated with decreased hospital discharge rates (P = 0.003, P = 0.045, and P < 0.001 respectively). Higher lactate levels (P = 0.009) and longer duration for normalization (P < 0.001) were both associated to failure to wean off ECLS support and, hence, to hospital deaths. The weaning rate was 36% prior to November 2012. It increased to 70.3% after that time (P = 0.009). The mechanical complication rate was 9% with the DP3 system and 32% with the DP2, which was statistically significant (P = 0.009). Additionally, the lactate levels were higher and decreased more slowly in the patients supported by the DP2. As a result of the shift to the DP3 system, a revised ECLS protocol, and increased ECLS experience, a significant improvement was observed in our clinical outcomes. The results of this study suggested that the combination of a DP3 pump and a Hilite oxygenator in pediatric ECLS circuits may improve durability and reduce circuit-induced complications.
机译：体外寿命支持（ECLS）在发生呼吸或心脏衰竭时，心脏手术后提供机械支持。本研究的目的是分析Medos Deltastream对角线泵（DP3）ECLS系统在儿科心脏病患者中的安全性和可行性。我们描述了与2011年3月至2016年3月期间收到ECLS支持的102名儿科心脏病患者的生存结果相关的技术考虑因素和危险因素。我们从DP2系统转换为最初的25名患者，以后的DP3系统2012年11月。然后在67名患者的连续系列中使用DP3（占所有儿科患者的4.5％在同一时间段内接受先天性心脏手术）。患者中位年龄为90天（范围：2天 - 12岁），而其中位数为4公斤（范围：2.1-40千克）。 50例患者（70％）被切断ECLS，而28名患者（36.3％）通过DP3系统从医院成功排出。幸存者的中位ECL持续时间为8.2天（范围：4-14.5天）。 ECLS指示，持续时间和发起时间在存活方面没有统计学意义。肾，出血和神经​​系统并发症均与病院排放率降低（P = 0.003，P = 0.045和P <0.001）相关。较高的乳酸水平（p = 0.009）和较长的归一化持续时间（p <0.001）与未能消除Ecls支持，因此对医院死亡均相关。断奶率为2012年11月之前的断奶率为36％。在此之后它增加到70.3％（P = 0.009）。机械并发症率为9％，DP3系统和32％，DP2具有统计学意义（P = 0.009）。另外，在DP2支持的患者中，乳酸水平较高并且更慢地降低。由于转移到DP3系统，修订的ECLS协议和增加的ECLS经验，在我们的临床结果中观察到显着改善。该研究的结果表明，DP3泵和小儿ECL电路中的Hilite氧吸收的组合可以提高耐久性并降低电路引起的并发症。

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