title: Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle: analysis of outcomes.
abstract: OBJECTIVE
  Extracorporeal cardiopulmonary resuscitation (ECPR) in children with cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) has been reported with encouraging results. We sought to review outcomes of neonates with functional single ventricle (FSV) receiving post-cardiotomy ECPR.
  
  
  METHODS
  Forty-eight patients who required post-cardiotomy extracorporeal membrane oxygenation (ECMO) since the introduction of our ECPR protocol (January 2007-December 2009) were identified. Twenty-seven were neonates. Review of records and survival analysis were conducted.
  
  
  RESULTS
  Of 27 neonates receiving post-cardiotomy ECMO 20 had FSV. Fourteen had ECPR. Ten underwent Norwood operation (NO) for hypoplastic left heart syndrome (HLHS). Four had FSV other than HLHS. Three underwent Damus-Kay-Stansel or modified NO with systemic-to-pulmonary shunt (SPS) and one SPS with anomalous pulmonary venous connection repair. Mean age and weight were 7.8 ± 2.9 days and 3.44 ± 1.78 kg, respectively. ECMO median duration was 6 days (interquartile range (IQR) 3-14). Survival to ECMO discontinuation was 79% (11 of 14 patients) and at hospital discharge was 57% (8 of 14 patients). The most common cause of death was multi-organ failure (four of six deaths). At last follow-up (median: 11 months (1-34)) 43% of patients were alive. CPR mean duration for patients with favorable versus unfavorable outcome was 38.6 ± 6.3 versus 42.1 ± 7.7 min (p = 0.12). Previously reported determinants for poorer prognosis in conventional non-rescue ECMO (such as pre-ECMO pH<7.2, renal, neurological or pulmonary hemorrhage complications, and pre- and post-vasoactive inotropic score) did not influence outcome between survivors and non-survivors (p>0.05).
  
  
  CONCLUSIONS
  ECMO support in neonates with FSV requiring ECPR can result in favorable outcome in more than half of patients at hospital discharge. Aggressive strategy toward timely application of ECPR is justified. Expeditious ECPR deployment after proper patients' selection, refinement of CPR quality and use of adjunctive neuroprotective interventions, such as induced hypothermia, might further improve outcomes.
authors.affiliation: Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, IL 60612-3244, USA. Anastasios_c_polimenakos@rush.edu
authors.forename: Anastasios C
authors.initials: AC
authors.lastname: Polimenakos
authors.forename: Patrice
authors.initials: P
authors.lastname: Wojtyla
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Smith
authors.forename: Vincent
authors.initials: V
authors.lastname: Rizzo
authors.forename: Melissa
authors.initials: M
authors.lastname: Nater
authors.forename: Chawki F
authors.initials: CF
authors.lastname: El Zein
authors.forename: Michel N
authors.initials: MN
authors.lastname: Ilbawi
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004812:Epidemiologic Methods; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007231:Infant, Newborn; D019344:Lactic Acid / Q000097:blood; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000628:therapy; D011184:Postoperative Period; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D019344:Lactic Acid