Outcomes among neonates, infants, and children after extracorporeal cardiopulmonary resuscitation for refractory inhospital pediatric cardiac arrest: a report from the National Registry of Cardiopulmonary Resuscitation.
ABSTRACT Describe the use of extracorporeal cardiopulmonary resuscitation as rescue therapy in pediatric patients who experience cardiopulmonary arrest refractory to conventional resuscitation. We report on outcomes and factors associated with survival in children treated with extracorporeal cardiopulmonary resuscitation during cardiopulmonary arrest from the American Heart Association National Registry of CardioPulmonary Resuscitation.
Multicentered, national registry of in-hospital cardiopulmonary resuscitation.
Two hundred eighty-five hospitals reporting to the registry from January 2000 to December 2007.
Pediatric patients <18 yrs of age who received extracorporeal membrane oxygenation during cardiopulmonary resuscitation for in-hospital cardiopulmonary arrest.
None. MEASUREMENTS AND OUTCOMES: Prearrest and arrest variables were collected. The primary outcome variable was survival to hospital discharge. The secondary outcome was neurologic status after extracorporeal cardiopulmonary resuscitation at hospital discharge. Favorable neurologic outcome was defined as Pediatric Cerebral Performance Categories 1, 2, 3, or no change from admission Pediatric Cerebral Performance Category.
Of 6288 pediatric cardiopulmonary arrest events reported, 199 (3.2%) index extracorporeal cardiopulmonary resuscitation events were identified; 87 (43.7%) survived to hospital discharge. Fifty-nine survivors had Pediatric Cerebral Performance Category outcomes recorded, and of those, 56 (94.9%) had favorable outcomes. In a multivariable model, the prearrest factor of renal insufficiency and arrest factors of metabolic or electrolyte abnormality and the pharmacologic intervention of sodium bicarbonate/tromethamine were associated with decreased survival. After adjusting for confounding factors, cardiac illness category was associated with an increased survival to hospital discharge.
Forty-four percent of pediatric patients who failed conventional cardiopulmonary resuscitation from in-hospital cardiopulmonary arrest and who were reported to the National Registry of CardioPulmonary Resuscitation database as treated with extracorporeal cardiopulmonary resuscitation survived to hospital discharge. The majority of survivors with recorded neurologic outcomes were favorable. Patients with cardiac illness category were more likely to survive to hospital discharge after treatment with extracorporeal cardiopulmonary resuscitation. Extracorporeal cardiopulmonary resuscitation should be considered for select pediatric patients refractory to conventional in-hospital resuscitation measures.
Full-textDOI: · Available from: Tia Tortoriello Raymond, May 29, 2015
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ABSTRACT: Extracorporeal cardiopulmonary resuscitation (ECPR) remains a promising treatment for pediatric patients in cardiac arrest unresponsive to traditional cardiopulmonary resuscitation. With venoarterial extracorporeal support, blood is drained from the right atrium, oxygenated through the extracorporeal circuit, and transfused back to the body, bypassing the heart and lungs. The use of artificial oxygenation and perfusion thus provides the body a period of hemodynamic stability, while allowing resolution of underlying disease processes. Survival rates for ECPR patients are higher than those for traditional cardiopulmonary resuscitation (CPR), although neurological outcomes require further investigation. The impact of duration of CPR and length of treatment with extracorporeal membrane oxygenation vary in published reports. Furthermore, current guidelines for the initiation and use of ECPR are limited and may lead to confusion about appropriate use of this support. Many ethical concerns arise with this advanced form of life support. More often than not, the dilemma is not whether to withhold ECPR, but rather when to withdraw it. Although clinicians must decide if ECPR is appropriate and when further intervention is futile, the ultimate burden of choice is left to the patient's caregivers. Offering support and guidance to the patient's family as well as the patient is essential. ©2015 American Association of Critical-Care Nurses.Critical Care Nurse 02/2015; 35(1):60-9. DOI:10.4037/ccn2015655 · 1.07 Impact Factor
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ABSTRACT: To describe the risk factors for acquiring functional or cognitive disabilities during admission to a PICU.Pediatric Critical Care Medicine 07/2014; 15(7). DOI:10.1097/PCC.0000000000000199 · 2.33 Impact Factor
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ABSTRACT: Objective to analyze the mortality and neurological outcome factors of in-pediatric intensive care unit (PICU) cardiac arrest (CA) in a multicenter international study. Patients and methods prospective observational multicenter study in Latin-American countries, Spain, Portugal, and Italy. 250 children aged from 1 month to 18 years who suffered in-PICU CA were studied. Countries and patient-related variables, arrest life, support-related variables, procedures and clinical and neurological status at hospital discharge according to the Pediatric Cerebral Performance Category (PCPC) scale were registered. The primary endpoint was survival at hospital discharge and neurological outcome at the same time was the secondary endpoint. Univariate and multivariate logistic regression analyses were performed. Results Return of spontaneous circulation maintained longer than 20 minutes was achieved in 172 patients (69.1%) and 101 (40.4%) survived to hospital discharge. In the univariate analysis oncohematologic diseases, inotropic infusion at the time of CA, sepsis and neurologic causes of CA, primary cardiac arrest, need of adrenaline, bicarbonate or volume expansion during resuscitation, and long duration of resuscitation were related with mortality. In the multivariate logistic regression analysis factors related with mortality were hemato-oncologic illness and previous treatment with vasoactive drugs at the time of CA event, neurological etiology of CA, and CPR duration for more than 10 minutes. One year after CA, neurological status assessed in 65 patients; among them 81.5% had mild disabilities or none. Conclusions Survival with good neurological outcome of CA in the PICU is improving. The most important prognostic indicator is the duration of resuscitation.Resuscitation 10/2014; 85(10). DOI:10.1016/j.resuscitation.2014.06.024 · 3.96 Impact Factor