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Survival outcomes after extracorporeal cardiopulmonary resuscitation instituted during active chest compressions following refractory in-hospital pediatric cardiac arrest*

Morris, Marilyn C. MD; Wernovsky, Gil MD; Nadkarni, Vinay M. MD, FAAP, FCCM

Pediatric Critical Care Medicine: September 2004 - Volume 5 - Issue 5 - p 440-446
doi: 10.1097/01.PCC.0000137356.58150.2E
Feature Article—Continuing Medical Education

Objective: To report survival outcomes and to identify factors associated with survival following extracorporeal cardiopulmonary resuscitation for in-hospital pediatric cardiac arrest.

Design: Retrospective chart review, consecutive case series.

Main Outcome Measure: Survival to hospital discharge.

Results: 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.

Conclusions: 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.

Assistant Professor of Clinical Pediatrics, The Children’s Hospital of New York, New York, NY (MCM); Director of Program Development, Cardiac Center, Staff Cardiologist, Cardiac Intensive Care Unit, Cardiac Care Center Attending Cardiologist, Associate Professor in Pediatrics, The Children’s Hospital of Philadelphia, the University of Pennsylvania School of Medicine, Philadelphia, PA (GW); and Associate Professor of Anesthesiology and Pediatrics, Director, Pediatric Critical Care Fellowship Program, The Children’s Hospital of Philadelphia, the University of Pennsylvania School of Medicine, Philadelphia, PA (VMN).

*See also p. 495.

©2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies