Pediatric extracorporeal cardiopulmonary resuscitation: single-center study

Abstract

Background/aim Extracorporeal cardiopulmonary resuscitation (ECPR) is defined as the venoarterial extracorporeal membrane oxygenation (VA-ECMO) support in a patient who experienced a sudden pulseless condition attributable to cessation of cardiac mechanical activity and circulation. We aimed to evaluate the clinical outcomes of our ECPR experience in a pediatric patient population. Materials and methods Between September 2014 and November 2017, 15 children were supported with ECPR following in-hospital cardiac arrest (IHCA) in our hospitals. VA-ECMO setting was established for all patients. Pediatric cerebral performance category (PCPC) scales and long-term neurological prognosis of the survivors were assessed. Results The median age of the study population was 60 (4–156) months. The median weight was 18 (4.8–145) kg, height was 115 (63–172) cm, and body surface area was 0.73 (0.27–2.49) m 2 . The cause of cardiac arrest was a cardiac and circulatory failure in 12 patients (80%) and noncardiac causes in 20%. Dysrhythmia was present in 46%, septic shock in 13%, bleeding in 6%, low cardiac output syndrome in 13%, and airway disease in 6% of the study population. Median low-flow time was 95 (range 20–320) min. Central VA-ECMO cannulation was placed in only 2 (13.3%) cases. However, the return of spontaneous circulation (ROSC) was obtained in 10 (66.6%) patients, and 5 (50%) of them survived. Overall, 5 patients were discharged from the hospital. Finally, survival following ECPR was 33.3%, and all survivors were neurologically intact at hospital-discharge. Conclusion ECPR can be a life-saving therapeutic strategy using a promising technology in the pediatric IHCA population. Early initiation and a well-coordinated, skilled, and dedicated ECMO team are the mainstay for better survival rates.

Predictors of survival for pediatric extracorporeal cardiopulmonary resuscitation: A systematic review and meta-analysis

“…This pattern was also seen in pulmonary hypertension prior to ECPR (RR = 0.44 [0.12-1.61], I 2 = 0%, P = .22). Finally, the odds of SV physiology were not significantly different in the Alsoufi, B., 2014 [25] Saudi Arabia 2007-2012 39 14 41 IHCA R Anton-Martin, P., 2020 [26] USA 2000-2013 73 26 44 IHCA R Bembea, M., 2019 [27] USA 2000-2014 593 242 41 IHCA R Beshish, A., 2018 [28] USA 2005-2015 80 40 48 IHCA R Brunner, A., 2016 [29] Switzerland 2008-2014 19 NR 16 Both R Chen, G., 2018 [30] Asia Pacific 1999-2016 321 142 51 IHCA R Chrysostomou, C., 2013 [31] USA 2006-2010 40 15 75 NR R De Mul, A., 2019 [32] Switzerland 2008-2016 55 20 25 Both R Erek, E., 2017 [33] Turkey 2010-2014 25 NR 20 IHCA R Guo, Z., 2019 [34] China 2017 11 3 36 IHCA R Huang, S., 2012 [35] Taiwan 1999-2009 54 17 46 IHCA R Jolley, M., 2014 [36] Multi 1998-2013 293 121 36 IHCA R Kane, D., 2010 [37] USA 1995-2009 172 77 51 IHCA R KendIrlI, T., 2020 [38] Turkey 2014-2017 15 8 33 IHCA R Kramer, P., 2020 [39] Germany 2005-2016 72 34 36 Both R McMullan, D., 2014 [40] Multi 1998-2010 641 257 39 NR R Melvan, J., 2020 [41] USA 2002-2017 184 92 43 NR R Philip, J., 2014 [42] USA 2005-2012 59 NR 46 IHCA R Polimenakos, A., 2017 [43] USA 2007-2011 21 NR 62 IHCA R Raymond, T., 2010 [44] USA 2000-2007 199 75 44 IHCA R Shakoor, A., 2019 [45] USA 2010-2017 70 28 54 IHCA R Shin, H., 2016 [46] SK 2013-2016 12 6 33 NR R Sivarajan, V., 2011 [47] Australia 2002-2006 37 18 38 NR R Topjian, A., 2019 [48] Multi 2009-2015 157 57 46 IHCA R Torres-Andres, F., 2018 [49] USA 2007-2015 58 23 65.5 Both R Tsukahara, K., 2014 [50] Japan 2003-2012 21 8 14 Both R Walter, E., 2011 [51] Germany 1992-2008 42 19 40 IHCA R Wolf, M., 2012 [52] USA 2002-2011 90 NR 56 IHCA R Yates, A., 2019 …”

The Role of Extracorporeal Cardiopulmonary Resuscitation in Pediatric Intraoperative Cardiac Arrest

“…The 2020 ELSO registry found that ECPR accounts for 11.6% of all pediatric ECMO cases. Survival rates were superior in the pediatric group (42%) in comparison to the adult group (29%) [7]. Multiple studies in adults have demonstrated improved survival with ECPR compared to conventional CPR, considering survival to discharge and neurological impairment outcomes [3].…”

“…Despite the reported incremental trend over the last decade in ECPR statistics, the current pediatric advanced life support guidelines are still reluctant to employ this intervention. This position is mainly due to the limited evidence regarding its beneficial impact on survival rates and functional outcomes [7].…”

“…A well-coordinated team of expert-trained professionals is essential. After the establishment of the process, the next essential step is to review the institutional experience by monitoring and evaluating outcomes to guide progress and improvement measures [3,7].…”

Extracorporeal cardiopulmonary resuscitation in adults and children: A review of literature, published guidelines and pediatric single-center program building experience

“…A meta-analysis including 762 patients by Joffe et al ( 155 ) described overall ECPR survival of 49%, with favorable neurological outcomes occurring in 79% of survivors and non-cardiac disease associated with increased risk of mortality. Other retrospective single, multicenter, and database studies describe 25–73% overall survival and 50–100% of survivors having good neurologic outcome ( 137 , 145 , 147 , 149 , 156 , 159 – 176 ).…”