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

Abstract

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.

Rescue extracorporeal cardiopulmonary resuscitation in pediatric patients: a nine-year single-center experience in Zagreb, Croatia

“…Pilar et al found that E-CPR longer than 50 minutes predicted the fatal outcome. They, however, described three patients who survived very long CPR episodes (118, 134, and 139 min) with mild neurological deficits, similar to the results of our study (15). This findings indicate that survival without neurological impairment can be expected even in CPR lasting more than one hour.…”

“…All of them survived without neurological impairment. It is a subject to discussion whether therapeutic hypothermia can improve the neurological outcome after CPR ( 15 ). None of our 16 E-CPR patients underwent therapeutic hypothermia, but hyperthermia was agressively treated.…”

“…In the single-center experience of pediatric E-CPR by Pilar et al, CPRs were longer than 30 minutes. They found a strong difference between survivors and non-survivors in ECMO team response ( 15 ). Furthermore, survivors had a shorter median interval to ECMO team activation as well as shorter CPR and ECMO duration ( 15 ).…”

“…Other studies reported that the overall survival rate of pediatric E-CPR cases was growing, with better neurological outcomes than among the patients in the CPR group only ( 14 ). Pilar et al found that in 73 pediatric cardiac patients requiring cardiopulmonary resuscitation for >30 min ( 15 ), the survival to hospital discharge was 43.8%, with 3/4 of the patients having normal neurological function or mild neurological disability ( 15 ). Based on ELSO registry, approximately 10% of all ECMO patients meet brain death criteria ( 7 ).…”

“…Furthermore, common complications of ECMO treatment are fluid overload and acute kidney injury ( 18 ). Many studies showed renal replacement therapy (RRT) to be negatively associated with survival ( 15 , 16 , 18 , 19 ).…”