Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients.
OBJECTIVE
To describe survival and neurologic outcome and identify the factors associated with survival among pediatric patients following extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest.


METHODS
Retrospective study.


METHODS
A university-affiliated tertiary care hospital.


METHODS
Eligible patients were < or = 18 yrs of age and received extracorporeal membrane oxygenation during active cardiopulmonary resuscitation for in-hospital cardiac arrest.


METHODS
Extracorporeal membrane oxygenation (ECMO) during active cardiopulmonary resuscitation.


RESULTS
The primary outcome was survival to hospital discharge. The secondary outcome was neurologic status after ECPR at hospital discharge and late follow-up. Good neurologic outcome was defined as Pediatric Cerebral Performance Categories 1, 2, and 3. Continuous variables were expressed as medians (interquartile range). We prospectively defined the early cohort (January 1999 to December 2001) and late cohort (January 2002 to January 2006) and compared the survival rates. We identified 27 ECPR events. The survival rate to hospital discharge was 41% (11 of 27). The nonsurvivors had higher pre-cardiopulmonary resuscitation serum lactate levels (14 [10.2-19.6] mmol/L vs. 8.5 [4.4-12.6] mmol/L, p < .01), longer durations of cardiopulmonary resuscitation (60 [37-81] mins vs. 45 [25-50] mins, p < .05) with longer activating time for ECMO (12.5 [7.5-33.8] mins vs. 5 [0-10] mins, p < .01), and more renal failure after ECPR (68% [11 of 16] vs. 9% [1 of 11], p < .01). The survival rate of the late cohort was better than that of the early cohort (58% [11 of 19] vs. 0% [0 of 8], p < .05). By exact multiple logistic regression analysis, the early cohort and renal failure after ECPR were two independent risk factors for mortality. Among the 11 survivors, ten had good neurologic outcomes.


CONCLUSIONS
ECPR successfully rescued some pediatric patients who failed rescue with conventional in-hospital CPR. Good neurologic outcomes were achieved in the majority of the survivors. Early cohort and post-ECPR renal failure were associated with mortality.
Huang
Shu-Chien
SC
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Wu
En-Ting
ET
Chen
Yih-Sharng
YS
Chang
Chung-I
CI
Chiu
Ing-Sh
IS
Wang
Shoei-Shen
SS
Lin
Fang-Yue
FY
Ko
Wen-Je
WJ
D000293:Adolescent; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate