Nature of the underlying heart disease affects survival in pediatric patients undergoing extracorporeal cardiopulmonary resuscitation

Philip, Joseph; Burgman, Cole; Bavare, Aarti; Akcan-Arikan, Ayse; Price, Jack F.; Adachi, Iki; Shekerdemian, Lara

doi:10.1016/j.jtcvs.2014.03.023

Cited by 30 publications

(26 citation statements)

References 27 publications

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“…The primary finding of our study is that our cohort of patients had an overall survival to hospital discharge of 43.8%, with 75% of these patients having either normal neurologic function or only mild disability. Our reported survival is comparable to previous paediatric cardiac extracorporeal cardiopulmonary resuscitation studies that reported a survival of 20-46%, 2,11,12,[18][19][20][21][22][23][24] but differs from other studies with more favourable extracorporeal cardiopulmonary resuscitation survival rates of 51-79%. Many prior studies of extracorporeal cardiopulmonary resuscitation include patients with wide ranges of duration of chest compressions prior to cannulation, some of them including patients receiving less than 10 minutes of cardiopulmonary resuscitation prior to placement on mechanical support.…”

Section: Discussionsupporting

confidence: 77%

Outcomes of paediatric cardiac patients after 30 minutes of cardiopulmonary resuscitation prior to extracorporeal support

et al. 2020

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Objectives:To characterise the mortality and neurological outcomes of paediatric cardiac patients requiring cardiopulmonary resuscitation for more than 30 minutes prior to extracorporeal membrane oxygenation cannulation and to identify risk factors associated with adverse outcomes in this population.Materials and methods:Observational retrospective cohort study in paediatric cardiac patients undergoing cardiopulmonary resuscitation for greater than 30 minutes prior to cannulation in a tertiary children’s hospital, from July 2000 to July 2013.Results:Seventy-three paediatric cardiac patients requiring cardiopulmonary resuscitation for more than 30 minutes prior to cannulation were included in the study. Survival to hospital discharge was 43.8%, with 75% of survivors having either normal neurologic function or only mild disability. Multivariable logistic regression analysis demonstrated that increased use of calcium during resuscitation (odds ratio 14.5, p 0.01), cardiopulmonary resuscitation duration >50 minutes (odds ratio 4.12, p 0.03), >6 interruptions of chest compressions during cannulation (odds ratio 6.40, p 0.03), the need for continuous renal replacement therapy (odds ratio 11.1, p 0.001), and abnormal pupillary response during extracorporeal membrane oxygenation (odds ratio 33.9, p 0.006) were independent predictors for hospital mortality.Conclusion:Survival after cardiopulmonary resuscitation for more than 30 minutes prior to extracorporeal membrane oxygenation cannulation in our paediatric cardiac cohort was 43.8%. Factors associated with mortality included calcium use during resuscitation, longer cardiopulmonary resuscitation, increased chest compression pauses during cannulation, the use of continuous renal replacement therapy, and abnormal pupils during extracorporeal membrane oxygenation support. A prospective assessment of these factors in paediatric cardiac patients may be beneficial in improving outcomes.

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Section: Discussionsupporting

confidence: 77%

Outcomes of paediatric cardiac patients after 30 minutes of cardiopulmonary resuscitation prior to extracorporeal support

et al. 2020

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“…Current evidence in the pediatric literature describing the frequency of ECMO cannulation site and its impact on outcomes remains limited to a small number of retrospective single-center studies and ELSO registry analyses. These studies present conflicting conclusions regarding the impact of carotid versus femoral and/or central cannulation on mortality and CNS injury (6, 8, 9, 18, 35, 36). Furthermore, results in these investigations often describe a wide variety of patients undergoing veno-arterial (VA) ECMO (cardiac, respiratory, or E-CPR) further limiting our ability to distinguish associations with mortality and/or neurologic outcomes specifically within the E-CPR population (37–39).…”

Section: Discussionmentioning

confidence: 99%

“…Effective and efficient E-CPR requires a complex interplay of care made up of dedicated personnel, equipment, and clinical expertise. Although E-CPR has evolved from its origins in the management of pediatric postcardiotomy cardiac arrest patients to include noncardiac and adult patient populations (1–7), it remains commonly used by patients with congenital and acquired heart disease (8–18). Many retrospective reports of E-CPR use in the pediatric cardiac population have investigated risk factors for mortality and neurologic outcome; yet, our understanding of the inter- and intrainstitutional variability in the process of E-CPR is lacking.…”

mentioning

confidence: 99%

Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Cardiac Population: In Search of a Standard of Care*

Lasa¹,

Jain²,

Raymond

et al. 2018

Pediatric Critical Care Medicine

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Objectives: Although clinical and pharmacologic guidelines exist for the practice of cardiopulmonary resuscitation in children (Pediatric Advanced Life Support), the practice of extracorpo-real cardiopulmonary resuscitation in pediatric cardiac patients remains without universally accepted standards. We aim to explore variation in extracorporeal cardiopulmonary resuscitation procedures by surveying clinicians who care for this high-risk patient population. Design: A 28-item cross-sectional survey was distributed via a web-based platform to clinicians focusing on cardiopulmonary resuscitation practices and extracorporeal membrane oxygenation team dynamics immediately prior to extracorporeal membrane oxygenation cannulation. Settings: Pediatric hospitals providing extracorporeal mechanical support services to patients with congenital and/or acquired heart disease. Subjects: Critical care/cardiology specialist physicians, cardiothoracic surgeons, advanced practice nurse practitioners, respiratory therapists, and extracorporeal membrane oxygenation specialists. Interventions: None. Measurements and Main Results: Survey web links were distributed over a 2-month period with critical care and/or cardiology physicians comprising the majority of respondents (75%). Nearly all respondents practice at academic/teaching institutions (97%), 89% were from U.S./Canadian institutions and 56% reported less than 10 years of clinical experience. During extracorporeal cardiopulmonary resuscitation, a majority of respondents reported adherence to guideline recommendations for epinephrine bolus dosing (64%). Conversely, 19% reported using only one to three epinephrine bolus doses regardless of extracorporeal cardiopulmonary resuscitation duration. Inotropic support is held after extra-corporeal membrane oxygenation cannulation “most of the time” by 58% of respondents and 94% report using afterload reducing/antihypertensive agents “some” to “most of the time” after achieving full extracorporeal membrane oxygenation support. Interruptions in chest compressions are common during active cannulation according to 77% of respondents. Conclusions: The results of this survey identify wide variability in resuscitative practices during extracorporeal cardiopulmonary resuscitation in the pediatric cardiac population. The deviations from established Pediatric Advanced Life Support CPR guidelines support a call for further inquiry into the pharmacologic and logistical care surrounding extracorporeal cardiopulmonary resuscitation. (Pediatr Crit Care Med 2018; 19:125–130)

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“…The published rates of survival to hospital discharge have varied widely. For cardiac ECMO‐cardiopulmonary resuscitation (eCPR), survival has been reported at 46% . For single ventricle patients, the overall survival rate has been reported at 37%, but for Glenn, Fontan, and total anomalous pulmonary venous connection patients, the survival rate is much lower yet .…”

Section: Discussionmentioning

confidence: 99%

Early catheterization after initiation of extracorporeal membrane oxygenation support in children is associated with improved survival

Abraham

Gilliam

Kim

et al. 2016

Cathet Cardio Intervent

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Nature of the underlying heart disease affects survival in pediatric patients undergoing extracorporeal cardiopulmonary resuscitation

Abstract: ECPR was associated with modest survival in pediatric patients with heart disease; however, this was associated in part with the underlying disease and pre-existing comorbidities, including the presence of acute kidney injury.

Cited by 30 publications

References 27 publications

Outcomes of paediatric cardiac patients after 30 minutes of cardiopulmonary resuscitation prior to extracorporeal support

Outcomes of paediatric cardiac patients after 30 minutes of cardiopulmonary resuscitation prior to extracorporeal support

Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Cardiac Population: In Search of a Standard of Care*

Early catheterization after initiation of extracorporeal membrane oxygenation support in children is associated with improved survival

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