To report survival outcomes and to identify factors associated with survival following extracorporeal cardiopulmonary resuscitation
for in-hospital pediatric cardiac arrest
Retrospective chart review, consecutive case series.
Main Outcome Measure:
Survival to hospital discharge.
During a 7-yr study period, there were 66 cardiac arrest
events in 64 patients in which a child
was cannulated for extracorporeal membrane oxygenation
during active cardiopulmonary resuscitation
with chest compressions. A total of 33 of 66 events (50%) resulted in the child
being decannulated and surviving at least 24 hrs; 21 of 64 (33%) children undergoing extracorporeal cardiopulmonary resuscitation
survived to hospital discharge. A total of 19 of 43 children with isolated heart disease compared with two of 21 children with other medical conditions survived to hospital discharge (p
< .01). Pediatric Cerebral Performance Category and Pediatric Overall Performance Category were determined for survivors >2 months old. Five of ten extracorporeal cardiopulmonary resuscitation
survivors >2 months old had no change in Pediatric Cerebral Performance Category or Pediatric Overall Performance Category compared with admission. Three of six extracorporeal cardiopulmonary resuscitation
patients who survived after receiving >60 mins of chest compressions before extracorporeal cardiopulmonary resuscitation
had grossly intact neurologic function. During a 2-yr period in the same hospital, no patient who received >30 mins of cardiopulmonary resuscitation
without extracorporeal cardiopulmonary resuscitation
survived. In this case series, age, weight, or duration of chest compressions before extracorporeal cardiopulmonary resuscitation
did not correlate with survival.
Extracorporeal cardiopulmonary resuscitation
can be used to successfully resuscitate selected children following refractory in-hospital cardiac arrest
, and can be implemented during active cardiopulmonary resuscitation
. Intact neurologic survival can sometimes be achieved, even when the duration of in-hospital cardiopulmonary resuscitation
is prolonged. In this series, children with isolated heart disease were more likely to survive following extracorporeal cardiopulmonary resuscitation
than were children with other medical conditions.