title: Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unit.
abstract: OBJECTIVE
  To describe our experience using extracorporeal cardiopulmonary resuscitation (ECPR) in resuscitating children with refractory cardiac arrest in the intensive care unit (ICU) and to describe hospital survival and neurologic outcomes after ECPR.
  
  
  METHODS
  A retrospective chart review of a consecutive case series of patients requiring ECPR from 2001 to 2006 at Arkansas Children's Hospital. Data from medical records was abstracted and reviewed. Primary study outcomes were survival to hospital discharge and neurological outcome at hospital discharge.
  
  
  RESULTS
  During the 6-year study period, ECPR was deployed 34 times in 32 patients. 24 deployments (73%) resulted in survival to hospital discharge. Twenty-eight deployments (82%) were for underlying cardiac disease, 3 for neonatal non-cardiac (NICU) patients and 3 for paediatric non-cardiac (PICU) patients. On multivariate logistic regression analysis, only serum ALT (p-value=0.043; OR, 1.6; 95% confidence interval, 1.014-2.527) was significantly associated with risk of death prior to hospital discharge. Blood lactate at 24h post-ECPR showed a trend towards significance (p-value=0.059; OR, 1.27; 95% confidence interval, 0.991-1.627). The Hosmer-Lemeshow tests (p-value=0.178) suggested a good fit for the model. Neurological evaluation of the survivors revealed that there was no change in PCPC scores from a baseline of 1-2 in 18/24 (75%) survivors.
  
  
  CONCLUSIONS
  ECPR can be used successfully to resuscitate children following refractory cardiac arrest in the ICU, and grossly intact neurologic outcomes can be achieved in a majority of cases.
authors.affiliation: Pediatric Critical Care Medicine, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, AR 72205, United States. prodhanparthak@uams.edu
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
authors.forename: Richard T
authors.initials: RT
authors.lastname: Fiser
authors.forename: Umesh
authors.initials: U
authors.lastname: Dyamenahalli
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gossett
authors.forename: Michiaki
authors.initials: M
authors.lastname: Imamura
authors.forename: Robert D B
authors.initials: RD
authors.lastname: Jaquiss
authors.forename: Adnan T
authors.initials: AT
authors.lastname: Bhutta
mesh_terms: D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D008297:Male; D015996:Survival Rate; D055815:Young Adult
chemical_list: D019344:Lactic Acid; D000410:Alanine Transaminase
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