Author/Editor		Primožič, Janez; Kalan, Gorazd; Grosek, Štefan; Vidmar, Ivan; Lazar, Inka; Kosin, Miro; Kovač, Anica; Janičijevič, Zdenka; Petreska, Mirjana
Title		Zunajtelesna membranska oksigenacija (ZTMO) pri otrocih - 12-letne izkušnje
Translated title		Extracorporeal membranous oxygenation (ECMO) in children - 12 years experience
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 75, št. 2
Publication year		2006
Volume		str. 61-70
Language		slo
Abstract		Background. Extracorporeal membranous oxigenation (ECMO) is an established treatment of children with severe yet amenable lung or heart failure. Methods. retrospective analysis of 12 years of experience (1994-2005) includes: a) ECMO treatment type, b) selection and status of children upon connection, c) percentage and quality of survival, d) influence of pre-ECMO risk factors on survival, and e) complications. Results. ECMO was applied in 18 children: veno-venous type in 6 (33%), veno-arterial in 12 (66%) children. All children had deep hipoxy and 80% probability of dying. There were 12 boys (66%) and 6 girls (34%). The majority were newborns-there were 12 (66%) while the other 6 children (34%) were aged 2 to 24 months. Average duration of ECMO in newborns was 131 hours (SD 83; range 27-288), and in older children 253 hours (151; 45-434). Average birth weight of newborns was 3190 g (654; 2320-4360), average gestation age 38.5 weeks (2.2; 34-41). Of the 18 children treated with ECMO, 11 survived (61%), while 4 died subsequently. Observed 24 hours after ECMO survival rate was higher in newborns (67%) than in older children (50%), but the difference was not statistically significant (p=0.627). Up to the present, 7 of the 11 have survived, five reached normal mental and physical development at final check-up, one has moderate motor disturbances with behavioural disorders, one has severe disability. It can be inferred that in addition to oxygenation index, plasma HCO3 level, mean arterial blood pressure and mean airway pressure before ECMO treatment are potential prognostic factors for newborn survival. Conclusions. The results of ECMO treatment justify the use and continuation of the ECMO programme in Slovenia.
Summary		Izhodišča. Zunajtelesna membranska oksigenacija (ZTMO) je ustaljen način zdravljenja otrok s hudo popravljivo odpovedjo pljuč ali srca. Metode. Retrospektivna analiza 12-letnih izkušenj (1994-2005) zajema: a) način izvajanja ZTMO, b) izbiro otrok ob priključitvi, c) kakovost preživetja otrok, d) vpliv neugodnih dejavnikov tveganja pred ZTMO na preživetje in e) zaplete. Rezultati. ZTMO smo uporabili pri 18 otrocih: vensko-venski način pri 6 (33%), vensko-arterijski pri 12 (66%) otrocih. Vsem otrokom je bila skupna globoka hipoksija organizma in 80% možnosti, da bodo umrli. Dečkov je bilo 12 (66%), deklic 6 (34%). Prevladovali so novorojenčki, ki jih je bilo 12 (66%), starejših otrok od 2. do 24. meseca starosti je bilo 6 (34%). Povprečno trajanje ZTMO je bilo pri novorojenčkih 131 ur (SD 83; razpon 27-288), pri starejših otrocih pa 253 ur (151; 45-434). Povprečna porodna teža novorojenčkov je bila 3190 g (654; 2320-4360), povprečna gestacijska starost 38,5 tedna (2,2;34-41). Od 18 otrok, zdravljenih z ZTMO, jih je preživelo 11 (61%), pri 4 je nastopila smrt kasneje. Preživetje 24 ur po ZTMO je bilo pri novorojenčkih boljše (67%) kot pri starejših otrocih (50%), a razlika med skupinama ni bila statistično značilna (p=0,627). Do danes je preživelo 7 od 11 otrok, pet jih je ob času pregleda doseglo normalen duševni in telesni razvoj, eden od otrok je motorično nespreten z vedenjskimi težavami, eden pa je hudo okvarjen. utemeljeno sklepamo, da so poleg oksigenacijskega indeksa tudi raven HCO3 v plazmi, srednji arterijski tlak in srednji tlak v dihalnih poteh pred zdravljenjem z ZTMO možni napovedni dejavniki za preživetje novorojenčkov. Zaključki. Rezultati zdravljenja z ZTMO upravičujejo uporabo in nadaljevanje programa ZTMO v Sloveniji.
Descriptors		EXTRACORPOREAL MEMBRANE OXYGENATION INTENSIVE CARE UNITS, PEDIATRIC RESPIRATORY INSUFFICIENCY HEART ARREST CHILD BIRTH WEIGHT GESTATIONAL AGE SURVIVAL ANALYSIS TREATMENT OUTCOME RETROSPECTIVE STUDIES