title: Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease.
abstract: BACKGROUND
  Survival of children with in-hospital cardiac arrest that does not respond to conventional cardiopulmonary resuscitation (CPR) is poor. We report on survival and early neurological outcomes of children with heart disease supported with rapid-response extracorporeal membrane oxygenation (ECMO) to aid cardiopulmonary resuscitation (ECPR).
  
  
  RESULTS
  Children with heart disease supported with ECPR were identified from our ECMO database. Demographic, CPR, and ECMO details associated with mortality were evaluated using multivariable logistic regression. Pediatric overall performance category and pediatric cerebral performance category scores were assigned to ECPR survivors to assess neurological outcomes. There were 180 ECPR runs in 172 patients. Eighty-eight patients (51%) survived to discharge. Survival in patients who underwent ECPR after cardiac surgery (54%) did not differ from nonsurgical patients (46%). Survival did not vary by cardiac diagnosis and CPR duration did not differ between survivors and nonsurvivors. Factors associated with mortality included noncardiac structural or chromosomal abnormalities (OR, 3.2; 95% CI, 1.3-7.9), use of blood-primed ECMO circuit (OR, 7.1; 95% CI, 1.4-36), and arterial pH <7.00 after ECMO deployment (OR, 6.0; 95% CI, 2.1-17.4). Development of end-organ injury on ECMO and longer ECMO duration were associated with increased mortality. Of pediatric overall performance category/pediatric cerebral performance category scores assigned to survivors, 75% had scores ≤2, indicating no to mild neurological injury.
  
  
  CONCLUSIONS
  ECPR may promote survival in children with cardiac disease experiencing cardiac arrest unresponsive to conventional CPR with favorable early neurological outcomes. CPR duration was not associated with mortality, whereas patients with metabolic acidosis and noncardiac structural or chromosomal anomalies had higher mortality.
authors.affiliation: Children's Hospital Boston, Department of Cardiology, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA. david.kane@cardio.chboston.org
authors.forename: David A
authors.initials: DA
authors.lastname: Kane
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.forename: David
authors.initials: D
authors.lastname: Wypij
authors.forename: Mark A
authors.initials: MA
authors.lastname: Scheurer
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.forename: Sitaram
authors.initials: S
authors.lastname: Emani
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: del Nido
authors.forename: Peter
authors.initials: P
authors.lastname: Betit
authors.forename: Peter C
authors.initials: PC
authors.lastname: Laussen
mesh_terms: D001900:Boston / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation; D016208:Databases, Factual; D018572:Disease-Free Survival; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000235:genetics / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors