title: Rescue extracorporeal membrane oxygenation in children with refractory cardiac arrest.
abstract: We describe our experience with extracorporeal cardiopulmonary resuscitation (CPR) using extracorporeal membrane oxygenation (ECMO) in children with refractory cardiac arrest, and determine predictors for mortality. ECMO support was instituted on 42 children, median age 0.7 years (1 day-17.8 years), median weight 7.05 (range 2.7-80) kg who suffered refractory cardiac arrest (1992-2008). Patients were postcardiotomy (n=27), or had uncorrected congenital heart diseases (n=3), cardiomyopathy (n=3), myocarditis (n=2), respiratory failure (n=3), or had trauma (n=4). Cannulation site was the chest in all except for three neonates who were cannulated through the neck vessels and two children who had femoral cannulation. ECMO was successfully discontinued in 17 patients. Primary cause of mortality was neurological injury. Pre-ECMO CPR duration for survivors against those who died was a mean of 35±1.3 min vs. a mean of 46±4.2 min. Age, weight, sex, anatomic diagnosis, etiology (surgical vs. medical) were not significant predictors of poor outcome. Prolonged CPR and high-dose inotropes are significant predictors of mortality. Rescue ECMO support in children with refractory cardiac arrest can achieve acceptable survival and neurological outcomes.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. delmo-walter@dhzb.de
authors.forename: Eva Maria
authors.initials: EM
authors.lastname: Delmo Walter
authors.forename: Vladimir
authors.initials: V
authors.lastname: Alexi-Meskishvili
authors.forename: Michael
authors.initials: M
authors.lastname: Huebler
authors.forename: Matthias
authors.initials: M
authors.lastname: Redlin
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Boettcher
authors.forename: Yuguo
authors.initials: Y
authors.lastname: Weng
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002316:Cardiotonic Agents / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005858:Germany; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents