Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle: analysis of outcomes

Polimenakos, Anastasios C.; Wojtyla, Patrice; Smith, Pamela J. Olúbùnmi; Rizzo, Vincent; Nater, Melissa; Zein, Chawki F. El; Ilbawi, Michel N.

doi:10.1016/j.ejcts.2011.01.087

Cited by 38 publications

(70 citation statements)

References 23 publications

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“…However, duration of CPR was identified as is a strong predictor of survival in a recent large, singlecenter study (15 min survivors vs. 40 min non-survivors, P=0.009), in which children who required ≥30 min of CPR had 79% reduced odds of hospital survival (24). Several single-center published reports do not identify duration of CPR as a predictor of ECPR survival but the difference in median duration of CPR between survivors and nonsurvivors was generally small (<5 min) (25)(26)(27). In contrast, pre-ECLS resuscitation >30 minutes has been identified as a significant independent risk factor of mortality in adults who experience out-of-hospital cardiac arrest (28).…”

Section: Duration Of Pre-ecpr Resuscitationmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation

Yam

McMullan

2017

Ann. Transl. Med.

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Extracorporeal life support (ECLS) is used for patients in isolated or combined cardiopulmonary failures. The use of ECLS to rescue patients with cardiac arrest that is refractory to conventional cardiopulmonary resuscitation has been shown to improve survival in many patient populations. Increasing recognition of the survival benefit associated with extracorporeal cardiopulmonary resuscitation (ECPR) has led to increased use of ECPR during the past decade. This review provides an overview of ECPR utilization; population-based clinical outcomes, resource utilization and costs associated this advanced form of life support therapy.

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Section: Duration Of Pre-ecpr Resuscitationmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation

Yam

McMullan

2017

Ann. Transl. Med.

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“…Several pediatric studies have shown increased mortality rates for patients cannulated after 30 minutes of conventional CPR. 7,11,28,34 However, other retrospective studies [8][9][10]12,20,26,27,29,31,32 of pediatric patients have shown positive outcomes with median CPR duration of 30 to 50 minutes. Even more interesting are the multiple case reports 24,27,30,32,37 of successful cannulation and survival to discharge in patients receiving CPR of up to 90 to 220 minutes.…”

Section: Population Of Patientsmentioning

confidence: 96%

“…Morris et al 32 Paden et al 2 Polimenakos et al 26 Prodhan et al 27 Raymond et al 8 Shah et al 33 Sivarajan et al 34 Thiagarajan et al 6 Tajik and Cardarelli 7 Wolf et al 24 Thourani et al 25 630 (40) 8 (57) 24 (72) 87 (44) 9 (33) 14 (38) 261 (38) 114 ( survive after treatment with ECPR. 8 Few published data support preexisting measurements as indicators for survival.…”

Section: Referencementioning

confidence: 99%

“…However, survival statistics for ECPR are more encouraging, with a general rate of success of near 40% to 60%. [2][3][4][5][7][8][9][10][11][12][13][19][20][21][22][23][24][25][26] Multi-institutional data obtained in 2012 from the Extracorporeal Life Support Organization (ELSO), an international registry and database of ECMO treatment, demonstrated that ECPR was successful for 934 out of 2236 neonatal and pediatric patients, with survival to discharge of 39% for neonates and 40% for children. Other retrospective, single-institution studies have shown survival rates as high as 72% to 80%.…”

Section: The Benefits Of Ecprmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest

Ryan

2015

Critical Care Nurse

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It is only fitting that the first neonate to be supported by extracorporeal membrane oxygenation (ECMO) was named Esperanza, which when translated from Spanish means hope.1 Indeed, to the more than 50 000 patients who have survived because of ECMO, this revolutionary treatment has provided hope where there was none before. 2 In the past 5 decades, the use of artificial oxygenation and perfusion has revolutionized the care of critically ill patients, both in the operating room and in the intensive care unit. Use of artificial oxygenation and perfusion has evolved from bypass during cardiac surgery to advanced life support, to complex extracorporeal cardiopulmonary resuscitation (ECPR). Within the past 20 years, ECPR has been initiated when traditional resuscitation methods have failed and has proven its effectiveness with a survival to discharge rate of approximately 40%.3-13 However, the appropriate use of this therapy and delineated criteria for initiating and withdrawing this therapy have yet to be defined. Furthermore, implementation of this Pediatric CareExtracorporeal cardiopulmonary resuscitation (ECPR) remains a promising treatment for pediatric patients in cardiac arrest unresponsive to traditional cardiopulmonary resuscitation. With veno-arterial extracorporeal support, blood is drained from the right atrium, oxygenated through the extracorporeal circuit, and transfused back to the body, bypassing the heart and lungs. The use of artificial oxygenation and perfusion thus provides the body a period of hemodynamic stability, while allowing resolution of underlying disease processes. Survival rates for ECPR patients are higher than those for traditional cardiopulmonary resuscitation (CPR), although neurological outcomes require further investigation. The impact of duration of CPR and length of treatment with extracorporeal membrane oxygenation vary in published reports. Furthermore, current guidelines for the initiation and use of ECPR are limited and may lead to confusion about appropriate use of this support. Many ethical concerns arise with this advanced form of life support. More often than not, the dilemma is not whether to withhold ECPR, but rather when to withdraw it. Although clinicians must decide if ECPR is appropriate and when further intervention is futile, the ultimate burden of choice is left to the patient's caregivers. Offering support and guidance to the patient's family as well as the patient is essential. (Critical Care Nurse. 2015;35[1]:60-70) This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Determine the difference between venovenous and venoarterial extracorporeal membrane oxygenation (ECMO) 2. Describe the benefits of extracorporeal cardiopulmonary resuscitation 3. Discuss the ethical considerations related to management of patients undergoing ECMO CNE Continuing Nursing Education

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“…1 Despite huge advances in ECMO hardware technology, intensive care unit (ICU) management, and more judicious indications to deploy ECMO, weaning from cardiac ECMO after congenital heart surgery or after rapid resuscitation for acute cardiac failure of any origin still ranges only between 56% and 79%. [2][3][4][5][6] Survival to hospital discharge is unfortunately even lower, ranging between 38% and 59%. [2][3][4][5][6][7] While increasingly precise protocols are being developed to guide ECMO management, it is still difficult to predict, in the first days after ECMO implantation, whether cardiac recovery is likely or not.…”

Section: Introductionmentioning

confidence: 99%

Troponin I Levels in Extracorporeal Membrane Oxygenation Following Congenital Heart Surgery

Rüffer

Münch

Potapov

et al. 2014

World J Pediatr Congenit Heart Surg

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Background: Correlating postcardiotomy extracorporeal membrane oxygenation (ECMO) troponin I (TnI) levels and outcomes. Methods: Between January 2006 and August 2010, 34 patients needed postcardiotomy ECMO for low cardiac output. Bailout ECMO was required either after unsuccessful weaning from bypass (n ¼ 17, 50%), postoperatively from prolonged hemodynamic failure (n ¼ 8, 23.5%), or following resuscitation (n ¼ 9, 26.5%). The TnI levels were measured following surgery or resuscitation during 10 days and compared between survivors (group I) and non-survivors (group II). Results: Median support duration was seven days (range: 0-31). Surgery involving hypoplastic aortic arch repair (Norwood palliation; n ¼ 7, 20.6%, or biventricular repair; n ¼ 11, 32.4%) led to most ECMO runs. Successful weaning from ECMO and hospital survival were 76.5% and 50%, respectively. In group I, peak TnI levels were reached by 24 hours postoperatively, comparable to levels in group II (36 + 34 vs 49 + 38 ng/mL; P ¼ .98). However, in group II, TnI levels formed a plateau by the second postoperative day, whereas group I showed a steep decline in TnI levels, suggesting myocardial recovery (P ¼ .028). All patients (n ¼ 4) who reached or maintained peak TnI levels at 48 hours died. On days 8, 9 and 10, TnI levels were significantly higher in group II (P ¼ .024, .019, and .013, respectively). Conclusions: Postcardiotomy ECMO was most commonly required after aortic arch repair. In the absence of ongoing myocardial insult due to ECMO hardware issues, coronary insufficiency or residual lesions, plateau TnI levels at 48 hours may seem to indicate an unfavorable outcome due to irreversible myocardial damage.

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Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle: analysis of outcomes

Cited by 38 publications

References 23 publications

Extracorporeal cardiopulmonary resuscitation

Extracorporeal cardiopulmonary resuscitation

Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest

Troponin I Levels in Extracorporeal Membrane Oxygenation Following Congenital Heart Surgery

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