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Extracorporeal Cardiopulmonary Resuscitation Outcomes in Term and Premature Neonates*

McMullan, David Michael MD1; Thiagarajan, Ravi R. MBBS, MPH2; Smith, Kendra M. MD3; Rycus, Peter T. MPH4; Brogan, Thomas V. MD5

Pediatric Critical Care Medicine: January 2014 - Volume 15 - Issue 1 - p e9–e16
doi: 10.1097/PCC.0b013e3182a553f3
Online Clinical Investigations

Objective: Extracorporeal cardiopulmonary resuscitation appears to improve survival in patients with acute refractory cardiopulmonary failure. This analysis was performed to determine survival outcomes and predictors of in-hospital mortality for term and preterm neonates who received extracorporeal cardiopulmonary resuscitation.

Design: Retrospective review of data from the Extracorporeal Life Support Organization international registry.

Setting: Pediatric and neonatal ICUs.

Patients: Infants less than or equal to 30 days.

Interventions: Extracorporeal cardiopulmonary resuscitation.

Measurements and Main Results: Demographic, clinical, and survival data from patients who received extracorporeal cardiopulmonary resuscitation between 1998 and 2010 were analyzed to determine factors that affect in-hospital mortality. Overall survival to hospital discharge for the 641 neonates who received extracorporeal cardiopulmonary resuscitation was 39%. In univariate analysis, gestational age correlated inversely with stroke (odds ratio, 0.84 [95% CI, 0.75–0.95]; p = 0.006) and death (odds ratio, 0.87 [95% CI, 0.78–0.96]; p = 0.005) as did corrected gestational age (odds ratio, 0.89 [95% CI, 0.81–0.97]; p = 0.006) and birth weight (odds ratio, 0.53 [95% CI, 0.38–0.74]; p < 0.001). Dysrhythmia as the primary diagnosis had significantly lower odds of death than single-ventricle cardiac disease (odds ratio, 0.24 [95% CI, 0.06–0.95]; p = 0.04). Higher pre-extracorporeal cardiopulmonary resuscitation oxygenation decreased the odds of death (odds ratio, 0.996 [95% CI, 0.994–0.999]; p = 0.01), whereas complications occurring on extracorporeal life support increased the odds of death. In the multivariate analysis, lower birth weight and pre-extracorporeal cardiopulmonary resuscitation oxygenation, as well as complications including CNS hemorrhage, pulmonary hemorrhage, acidosis, renal replacement therapy, and mechanical complications, increased the odds of death.

Conclusions: Overall survival for neonates receiving extracorporeal cardiopulmonary resuscitation is similar to older pediatric patients but decreases with lower gestational age and weight. Despite this, many low–birth weight neonates survive to hospital discharge.

1Division of Cardiac Surgery, Seattle Children’s Hospital, Seattle, WA.

2Department of Cardiology, Boston Children’s Hospital, Boston, MA.

3Division of Neonatology, Seattle Children’s Hospital, Seattle, WA.

4Extracorporeal Life Support Organization, University of Michigan, Ann Arbor, MI.

5Division of Critical Care Medicine, Seattle Children’s Hospital, Seattle, WA.

* See also p. 88.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: michael.mcmullan@seattlechildrens.org

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies