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Survival and Long-Term Functional Outcomes for Children With Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation

Torres-Andres, Francesc, MD1; Fink, Ericka, L., MD2; Bell, Michael, J., MD2; Sharma, Mahesh, S., MD3; Yablonsky, Eric, J., BS2; Sanchez-de-Toledo, Joan, MD, PhD2,4

Pediatric Critical Care Medicine: May 2018 - Volume 19 - Issue 5 - p 451–458
doi: 10.1097/PCC.0000000000001524
Cardiac Intensive Care

Objectives: To identify patient- and disease-related factors related to survival and favorable outcomes for children who underwent extracorporeal cardiopulmonary resuscitation after a refractory cardiac arrest.

Design: Retrospective observational study with prospective assessment of long-term functional outcome.

Patients: Fifty-six consecutive children undergoing extracorporeal cardiopulmonary resuscitation at our institution from 2007 to 2015. Median age at arrest was 3.5 months (interquartile range, 1–53).

Setting: Tertiary pediatric university hospital with a referral heart center.

Interventions: Health-related quality of life and family functioning assessment with the Pediatric Quality of Life Inventory and the McMaster Family Assessment Device.

Measurements and Main Results: Fifty-eight consecutive extracorporeal cardiopulmonary resuscitation episodes were included, with 46 (79.3%) related to primary cardiac conditions. Initial cannulation site was central in 19 (32.8%) and peripheral in 39 (67.2%). Survival to decannulation was 77.6% with survival at hospital discharge and at the end of the follow-up period being 65.5% and 62.1%, respectively. Time to follow-up was 38 months (interquartile range, 19–52). Patients who survived tended to be younger (3.5 mo [1 mo to 2 yr] vs 7 mo [1.25 mo to 17 yr]; p = 0.3) with decreased extracorporeal cardiopulmonary resuscitation times (28 min [15–47 min] vs 37.5 min [28.5–55 min]; p = 0.04). Those who received therapeutic hypothermia tended to have higher hospital survival (21/28 [75%] vs 16/29 [55%]; p = 0.08). Follow-up assessments of survivors demonstrated good quality of life and family functioning (Pediatric Quality of Life Inventory, 84 [76–89.5]; McMaster Family Assessment Device, 1.62 [1.33–1.83]).

Conclusions: In this series, extracorporeal cardiopulmonary resuscitation was associated with relatively high survival rates and a good health-related quality of life and family functioning. Larger series are needed to assess whether this technique should be more broadly available in the pediatric critical care community.

1Department of Neonatology, Hospital Clinic-Maternitat, ICGON-BCN Natal, Barcelona, Spain.

2Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Children’s Hospital Pittsburgh of UPMC, Pittsburgh, PA.

3Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Children’s Hospital Pittsburgh of UPMC, Pittsburgh, PA.

4Department of Pediatric Cardiology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.

Dr. Fink’s institution received funding from the National Institutes of Health (NIH) and the Patient-Centered Outcomes Research Institute, and she received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: joansdt@gmail.com

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies