title: Extracorporeal cardiopulmonary resuscitation for post-operative cardiac arrest: indications, techniques, controversies, and early results--what is known (and unknown).
abstract: Extracorporeal cardiopulmonary resuscitation may be defined as the use of extracorporeal membrane oxygenation for the support of patients who do not respond to conventional cardiopulmonary resuscitation. Data from national and international paediatric databases indicate that the use of extracorporeal cardiopulmonary resuscitation is increasing. Guidelines from the American Heart Association suggest that any patient with refractory cardiopulmonary resuscitation and potentially reversible causes of cardiac arrest is a candidate for extracorporeal cardiopulmonary resuscitation. One possible framework for selection of patients for extracorporeal cardiopulmonary resuscitation includes dividing patients on the basis of favourable or unfavourable characteristics. Favourable characteristics include cardiac disease, witnessed event in the intensive care unit, ability to deliver effective cardiopulmonary resuscitation, active patient monitoring present, favourable arterial blood gases, and early institution of extracorporeal membrane oxygenation. Unfavourable characteristics potentially include non-cardiac disease, an unwitnessed cardiac arrest, ineffective cardiopulmonary resuscitation, and severely acidotic arterial blood gases. Considering the significant resources and cost involved in the use of extracorporeal cardiopulmonary resuscitation, its use needs to be critically examined to improve outcomes, assess neurological recovery and quality of life, and help identify populations and other factors that may help guide in the selection of patients for successful extracorporeal cardiopulmonary resuscitation.
authors.affiliation: Pediatric Cardiac Surgery, The Congenital Heart Institute of Florida, 625 6th Avenue South, Saint Petersburg, FL 33701, USA. pjchai@gmail.com
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chai
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Dalton
authors.forename: John M
authors.initials: JM
authors.lastname: Costello
authors.forename: David S
authors.initials: DS
authors.lastname: Cooper
authors.forename: Roxanne
authors.initials: R
authors.lastname: Kirsch
authors.forename: Tami
authors.initials: T
authors.lastname: Rosenthal
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Graziano
authors.forename: James A
authors.initials: JA
authors.lastname: Quintessenza
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications; D013997:Time Factors; D016896:Treatment Outcome