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COVID-19儿童的体外膜氧合：系统回顾和荟萃分析
贵州医科大学 麻醉与心脏电生理课题 翻译: 邓举 编辑: 严旭 审校: 曹莹 目的：患COVID-19相关疾病儿童的体外膜氧合（ECMO）的适应症、并发症和预后仍未阐明。本研究旨在调查COVID-19相关疾病儿童ECMO的特征和预后。 数据来源：我们在2022年3月搜索了PubMed和EMBASE数据库。 入选研究：我们检索了所有涉及接受ECMO治疗的患COVID-19相关疾病的儿童（年龄≤18岁）的研究。 数据析取：两位作者独立提取了数据并评估了偏倚风险。采用随机效应模型的单组荟萃分析，综合了ECMO时的死亡率、脱机成功率和并发症。采用元回归分析的方法探讨死亡的危险因素。 数据综合：我们纳入了18项观察性研究、4个病例系列和22例报告，涉及110名接受ECMO治疗COVID-19相关疾病的儿童。年龄中位数为8岁（范围，10 天至18岁），体重指数中位数为21.4kg/m2（范围，12.3–56.0kg/m2）。最常见的合并症是肥胖（11%[7/63]）和先天性心脏病(11%[7/63])，而48%（30/63）患儿以前都很健康。ECMO最常见的适应症是儿童的多系统炎症综合征（52% [47/90]）和严重急性呼吸窘迫综合征（40% [36/90]）。71%（56/79）患儿接受了静脉动脉-ECMO治疗。静脉动脉-ECMO的运行时间中位数为6天（范围3-51天），静脉静脉ECMO为11天（范围3-71天）。死亡率为26.6%（95% CI，15.9-40.9），脱机成功率为77.0%（95% CI，55.4-90.1）。在ECMO治疗中，有37.0%的（95%CI，23.1-53.5）患者出现并发症，包括中风、急性肾损伤、肺水肿和血栓栓塞。糖皮质类固醇和静脉注射免疫球蛋白治疗与较低的死亡率相关。
结论：用ECMO治疗COVID-19患儿的死亡率相对较低。这种侵入性治疗可作为COVID-19危重患儿的一种治疗选择。 原始文献来源 ： Atsuyuki Watanabe, Jun Yasuhara,Takaharu Karube,et al.Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis［J］.Pediatric Critical Care Medicine 2023;5(24): 406−416 .  英文原文： Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis Abstract OBJECTIVES: The indication, complications, and outcomes of extracorporeal membrane oxygenation (ECMO) in children with COVID-19–related illnesses remain unelucidated. Our study aimed to investigate the characteristics and outcomes of ECMO in children with COVID-19–related illnesses. DATA SOURCES: We searched PubMed and EMBASE databases in March 2022. STUDY SELECTION: We retrieved all studies involving children (age ≤ 18 yr) with COVID-19–related illnesses who received ECMO. DATA EXTRACTION: Two authors independently extracted data and assessed the risk of bias. Mortality, successful weaning rate, and complications while on ECMO were synthesized by a one-group meta-analysis using a random-effect model. Meta-regression was performed to explore the risk factors for mortality. DATA SYNTHESIS: We included 18 observational studies, four case series, and 22 case reports involving 110 children with COVID-19–related illnesses receiving ECMO. The median age was 8 years (range, 10 d to 18 yr), and the median body mass index was 21.4kg/m2 (range, 12.3–56.0kg/m2). The most common comorbidities were obesity (11% [7/63]) and congenital heart disease (11% [7/63]), whereas 48% (30/63) were previously healthy. The most common indications for ECMO were multisystem inflammatory syndrome in children (52% [47/90]) and severe acute respiratory distress syndrome (40% [36/90]). Seventyone percent (56/79) received venoarterial-ECMO. The median ECMO runtime was 6 days (range, 3–51 d) for venoarterial ECMO and 11 days (range, 3–71 d) for venovenous ECMO. The mortality was 26.6% (95% CI, 15.9–40.9), and the successful weaning rate was 77.0% (95% CI, 55.4–90.1). Complications were seen in 37.0% (95% CI, 23.1–53.5) while on ECMO, including stroke, acute kidney injury, pulmonary edema, and thromboembolism. Corticosteroids and IV immunoglobulin therapies were associated with lower mortality. CONCLUSIONS: The mortality of children on ECMO for COVID-19 was relatively low. This invasive treatment can be considered as a treatment option for critically ill children with COVID-19.  |
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