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Extracorporeal Cardiopulmonary Resuscitation Among Patients with Structurally Normal Hearts

Conrad, Stephanie J.*; Bridges, Brian C.*; Kalra, Yuvraj; Pietsch, John B.; Smith, Andrew H.*

doi: 10.1097/MAT.0000000000000568
Clinical Critical Care

Extracorporeal cardiopulmonary resuscitation (eCPR) has been well described as a rescue therapy in refractory cardiac arrest among patients with congenital heart disease. The purpose of this retrospective analysis of data from the Extracorporeal Life Support Organization was to evaluate outcomes of eCPR in patients with structurally normal hearts and to identify risk factors that may contribute to mortality. During the study period, 1,431 patients met inclusion criteria. Median age was 16 years. Overall survival to hospital discharge was 32%. Conditional logistic regression demonstrated an independent survival benefit among smaller patients, patients with a lower partial pressure of carbon dioxide (PaCO2) on cannulation, and those with a shorter duration from intubation to eCPR cannulation. A diagnosis of sepsis was independently associated with a nearly threefold increase in odds of mortality, whereas the diagnosis of myocarditis portended a more favorable outcome. Neurologic complications, pulmonary hemorrhage, disseminated intravascular coagulation, CPR, pH less than 7.20, and hyperbilirubinemia after eCPR cannulation were independently associated with an increase in odds of mortality. When utilizing eCPR in patients with structurally normal hearts, a diagnosis of sepsis is independently associated with mortality, whereas a diagnosis of myocarditis is protective. Neurologic complications and pulmonary hemorrhage while on extracorporeal membrane oxygenation (ECMO) are independently associated with mortality.

From the *Division of Pediatric Critical Care, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital, Vanderbilt University, Nashville, Tennessee; Children’s of Alabama, Division of Pediatric Critical Care Medicine and Cardiology, Department of Pediatrics, University of Alabama, Birmingham, Alabama; and Department of Pediatric Surgery, Vanderbilt University, Nashville, Tennessee.

Submitted for consideration May 2016; accepted for publication in revised form March 2017.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Stephanie J. Conrad, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital, Vanderbilt University, 5118 Doctor’s Office Tower, 2200 Children’s Way, Nashville, TN, 37232. Email: Stephanie.j.conrad@vanderbilt.edu.

Copyright © 2017 by the American Society for Artificial Internal Organs