Article

Extracorporeal cardiopulmonary resuscitation for post-operative cardiac arrest: indications, techniques, controversies, and early results – what is known (and unknown)

Pediatric Cardiac Surgery, The Congenital Heart Institute of Florida, 625 6th Avenue South, Saint Petersburg, FL 33701, USA.
Cardiology in the Young (Impact Factor: 0.86). 12/2011; 21 Suppl 2(S2):109-17. DOI: 10.1017/S1047951111001685
Source: PubMed

ABSTRACT Extracorporeal cardiopulmonary resuscitation may be defined as the use of extracorporeal membrane oxygenation for the support of patients who do not respond to conventional cardiopulmonary resuscitation. Data from national and international paediatric databases indicate that the use of extracorporeal cardiopulmonary resuscitation is increasing. Guidelines from the American Heart Association suggest that any patient with refractory cardiopulmonary resuscitation and potentially reversible causes of cardiac arrest is a candidate for extracorporeal cardiopulmonary resuscitation. One possible framework for selection of patients for extracorporeal cardiopulmonary resuscitation includes dividing patients on the basis of favourable or unfavourable characteristics. Favourable characteristics include cardiac disease, witnessed event in the intensive care unit, ability to deliver effective cardiopulmonary resuscitation, active patient monitoring present, favourable arterial blood gases, and early institution of extracorporeal membrane oxygenation. Unfavourable characteristics potentially include non-cardiac disease, an unwitnessed cardiac arrest, ineffective cardiopulmonary resuscitation, and severely acidotic arterial blood gases. Considering the significant resources and cost involved in the use of extracorporeal cardiopulmonary resuscitation, its use needs to be critically examined to improve outcomes, assess neurological recovery and quality of life, and help identify populations and other factors that may help guide in the selection of patients for successful extracorporeal cardiopulmonary resuscitation.

0 Followers
 · 
145 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The field of extracorporeal support is moving forward rapidly. New technology, improved experience with a variety of patients, and successful outcomes in groups previously excluded from extracorporeal life support are increasing the use of this technique in patient support. Although initial reports of outcome are encouraging, they are often taken from single-center reports or large databases without specific detail to answer many of the relevant questions or for eras that do not reflect the effects of new technology. Collaboration between investigators, rigorous scientific data collection and analysis, and careful short- and long-term outcomes for patients receiving extracorporeal life support are imperative to avoid improper use of this high-resource, high-cost technology and to establish the efficacy of new devices and techniques. Bleeding and thrombosis remain devastating complications and efforts to reduce complications and improve anticoagulation regimens or eliminate the need for anticoagulation would be of major benefit to the field.
    Pediatric Critical Care Medicine 06/2013; 14(5):S94-S95. DOI:10.1097/PCC.0b013e318292e562 · 2.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The clinical management of patients on extracorporeal membrane oxygenation should be standardized and follow clear guidelines or protocols. However, due to the diversity of cannulation strategies and the complex situations that extracorporeal membrane oxygenation is now used in, each extracorporeal membrane oxygenation program has developed its own clinical management strategies. These vary widely across the globe. Extracorporeal membrane oxygenation provides partial or complete support of ventilation and oxygenation, as well as univentricular or biventricular support of myocardial function, either individually or in combination. High-flow extracorporeal membrane oxygenation can also provide circulatory support in profound vasoplegic shock. Improvements in technology and greater understanding of disease pathophysiology, coupled to refinements in technology, which lessen the adverse interaction between the circuit and the patient, all contribute to fewer mechanical and patient complications on extracorporeal membrane oxygenation. Earlier and more appropriate use of extracorporeal membrane oxygenation has been associated with improved patient outcomes. These clinical management strategies are reviewed in this article, part of the Pediatric Cardiac Intensive Care Society/Extracorporeal Life Support Organization Joint Statement on Mechanical Circulatory Support.
    Pediatric Critical Care Medicine 06/2013; 14(5):S13-S19. DOI:10.1097/PCC.0b013e318292ddc8 · 2.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this article, summary data from the annual international Extracorporeal Life Support Organization (ELSO) Registry Reports through July 2012 are presented. Nearly 51,000 patients have received extracorporeal life support (ECLS). Of the patients, 50% (>25,000) were neonatal respiratory failure, with a 75% overall survival to discharge or transfer. Congenital diaphragmatic hernia remains a major use of ECLS in this population with 51% survival. Extracorporeal life support use for pediatric respiratory failure has nearly doubled since 2000, with approximately 350 patients treated per year in the past 3 years examined (56% survival). Previously stable at about 100 cases a year for a decade, adult respiratory failure ECLS cases increased dramatically in 2009 with the H1N1 influenza pandemic and publication of the Conventional ventilation or ECMO for Severe Adult Respiratory failure (CESAR) trial results and have remained at approximately 400 cases a year through 2011 (55% survival). Use of ECLS for cardiac support represents a large area of consistent growth. Approximately 13,000 patients have been treated with survival to discharge rates of 40%, 49%, and 39% for neonates, pediatric, and adults, respectively.
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 05/2013; 59(3):202-10. DOI:10.1097/MAT.0b013e3182904a52 · 1.39 Impact Factor