Outcomes among neonates, infants, and children after extracorporeal cardiopulmonary resuscitation for refractory in-hospital pediatric cardiac arrest: A report from the National Registry of CardioPulmonary Resuscitation*

Pediatric Critical Care Medicine (Impact Factor: 2.34). 11/2009; 11(3):362-71. DOI: 10.1097/PCC.0b013e3181c0141b
Source: PubMed


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.

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Available from: Tia Tortoriello Raymond
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    • "(v) Unfortunately, many of the 'successfully rescued' patients have severe neurological impairments, which pose enormous economic and psychosocial burdens on patients, their families and also society. More recent reports on early better outcome categories [6] [7] stating no or mild neurological injury in 75% of the survivors remain to be proved by longer follow-up periods. Nevertheless, estimated survival free of neurological impairments is no >25–30%. "

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    ABSTRACT: Extracorporeal life support with artificial heart and lung for cardiopulmonary failure is commonly called extracorporeal membrane oxygenation (ECMO). ECMO can provide partial or total support, is temporary, and requires systemic anticoagulation. ECMO controls gas exchange and perfusion, stabilizes the patient physiologically, decreases the risk of ongoing iatrogenic injury, and allows ample time for diagnosis, treatment, and recovery from the primary injury or disease. ECMO is used in a variety of clinical circumstances and the results depend on the primary indication. ECMO provides life support but is not a form of treatment. Survival ranges from 30% in extracorporeal cardiopulmonary resuscitation to 95% for neonatal meconium aspiration syndrome. The major limitations to widespread applications are the need for anticoagulation and bleeding complications. However, nowadays, the new devices allow only minor bleeding that is rarely a fatal complication. Research on non-thrombogenic surfaces holds the promise of prolonged extracorporeal circulation without anticoagulation and without bleeding. The next decade may bring routine application of ECMO to all advanced Intensive Care Units where patients with profound respiratory and cardiac failure are treated.
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