title: Survival outcomes after rescue extracorporeal cardiopulmonary resuscitation in pediatric patients with refractory cardiac arrest.
abstract: OBJECTIVE
  We report our experience with extracorporeal cardiopulmonary resuscitation with extracorporeal membrane oxygenation in children having cardiac arrest refractory to conventional cardiopulmonary resuscitation and explore predictors for favorable outcome (survival with grossly intact neurologic status).
  
  
  METHODS
  We reviewed all patients who required extracorporeal cardiopulmonary resuscitation from 2000 to 2005. Multivariable regression analysis determined factors associated with favorable outcome and time-related survival.
  
  
  RESULTS
  Eighty children, median age 150 days (range: 1 day-17.6 years), required venoarterial extracorporeal cardiopulmonary resuscitation. There were several categories of disease among the patients: postcardiotomy (n = 39), unoperated congenital heart disease (n = 17), cardiomyopathy (n = 12), respiratory failure (n = 9), or myocarditis (n = 3). Cannulation sites were neck (n = 45) or chest (n = 36). Median duration of extracorporeal membrane oxygenation was 4 days (range: 1-22). Extracorporeal membrane oxygenation was successfully discontinued in 42 (54%) patients: wean (n = 35), heart transplantation (n = 7). Survival till hospital discharge was 27 (34%) patients. Most common cause of death was ischemic brain injury (n = 17). Twenty-four (30%) patients had a favorable outcome. Median duration of cardiopulmonary resuscitation for patients with favorable versus unfavorable outcome was 46 minutes (range: 14-95; interquartile range: 29-55) versus 41 minutes (range: 19-110; interquartile range: 30-55), P = .916. According to the logistic regression model, none of the following factors was a significant predictor of favorable outcome: age, weight, sex, etiology (cardiac vs noncardiac), duration of cardiopulmonary resuscitation, cannulation site, timing, or location of extracorporeal membrane oxygenation institution.
  
  
  CONCLUSIONS
  Acceptable survival and neurologic outcomes (30%) can be achieved with extracorporeal cardiopulmonary resuscitation in children after prolonged cardiac arrest (up to 95 minutes) refractory to conventional resuscitation measures. Heart transplantation is often needed for successful extracorporeal cardiopulmonary resuscitation exit strategy. Lack of predictors of poor outcome support aggressive attempts to initiate extracorporeal cardiopulmonary resuscitation in all patients, followed by subsequent assessment of organ salvage.
authors: Cardiac Centre, Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.
authors: Bahaaldin
authors: B
authors: Alsoufi
authors: Osman O
authors: OO
authors: Al-Radi
authors: Rakan I
authors: RI
authors: Nazer
authors: Colleen
authors: C
authors: Gruenwald
authors: Celeste
authors: C
authors: Foreman
authors: William G
authors: WG
authors: Williams
authors: John G
authors: JG
authors: Coles
authors: Christopher A
authors: CA
authors: Caldarone
authors: Desmond G
authors: DG
authors: Bohn
authors: Glen S
authors: GS
authors: Van Arsdell
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010348:Patient Care Team; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome