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Outcomes among neonates, infants, and children after extracorporeal cardiopulmonary resuscitation for refractory inhospital pediatric cardiac arrest: A report from the National Registry of Cardiopulmonary Resuscitation*

Raymond, Tia T. MD; Cunnyngham, Christopher B. MD; Thompson, Marita T. MD; Thomas, James A. MD; Dalton, Heidi J. MD; Nadkarni, Vinay M. MD

Pediatric Critical Care Medicine: May 2010 - Volume 11 - Issue 3 - p 362-371
doi: 10.1097/PCC.0b013e3181c0141b
Continuing Medical Education Articles

Objectives: Describe the use of extracorporeal cardiopulmonary resuscitation as rescue therapy in pediatric patients who experience cardiopulmonary arrest refractory to conventional resuscitation. We report on outcomes and factors associated with survival in children treated with extracorporeal cardiopulmonary resuscitation during cardiopulmonary arrest from the American Heart Association National Registry of CardioPulmonary Resuscitation.

Design: Multicentered, national registry of in-hospital cardiopulmonary resuscitation.

Setting: Two hundred eighty-five hospitals reporting to the registry from January 2000 to December 2007.

Patients: Pediatric patients <18 yrs of age who received extracorporeal membrane oxygenation during cardiopulmonary resuscitation for in-hospital cardiopulmonary arrest.

Interventions: None.

Measurements and Outcomes: Prearrest and arrest variables were collected. The primary outcome variable was survival to hospital discharge. The secondary outcome was neurologic status after extracorporeal cardiopulmonary resuscitation at hospital discharge. Favorable neurologic outcome was defined as Pediatric Cerebral Performance Categories 1, 2, 3, or no change from admission Pediatric Cerebral Performance Category.

Results: Of 6288 pediatric cardiopulmonary arrest events reported, 199 (3.2%) index extracorporeal cardiopulmonary resuscitation events were identified; 87 (43.7%) survived to hospital discharge. Fifty-nine survivors had Pediatric Cerebral Performance Category outcomes recorded, and of those, 56 (94.9%) had favorable outcomes. In a multivariable model, the prearrest factor of renal insufficiency and arrest factors of metabolic or electrolyte abnormality and the pharmacologic intervention of sodium bicarbonate/tromethamine were associated with decreased survival. After adjusting for confounding factors, cardiac illness category was associated with an increased survival to hospital discharge.

Conclusions: Forty-four percent of pediatric patients who failed conventional cardiopulmonary resuscitation from in-hospital cardiopulmonary arrest and who were reported to the National Registry of CardioPulmonary Resuscitation database as treated with extracorporeal cardiopulmonary resuscitation survived to hospital discharge. The majority of survivors with recorded neurologic outcomes were favorable. Patients with cardiac illness category were more likely to survive to hospital discharge after treatment with extracorporeal cardiopulmonary resuscitation. Extracorporeal cardiopulmonary resuscitation should be considered for select pediatric patients refractory to conventional in-hospital resuscitation measures.

Private Practice Physician (TTR), Pediatric Cardiac Intensivists of North Texas, PLLC, Medical City Children’s Hospital, Dallas, TX; Private Practice Physician (CBC), Methodist Hospital, San Antonio, TX; Associate Professor of Pediatrics (MTT, JAT), University of Texas Southwestern Medical Center, Dallas, TX; Chief of Critical Care (HJD), Phoenix Children’s Hospital, Phoenix, AZ; Director of Pediatric/Cardiac ICU (HJD), Phoenix Children’s Hospital, Phoenix, AZ; Endowed Chair (VMN), Pediatric Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA; Professor (VMN), Anesthesia, Critical Care, and Pediatrics, University of Pennsylvania, Philadelphia, PA; and Director (VMN), Center for Simulation, The Children’s Hospital of Philadelphia, Philadelphia, PA.

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©2010The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies