Extracorporeal cardiopulmonary resuscitation for pediatric cardiac patients.
BACKGROUND
Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to improve survival after in-hospital pediatric cardiac arrest. We describe our experience with ECPR for refractory cardiac arrest in pediatric cardiac patients.


METHODS
We performed a retrospective analysis of the use of venoarterial extracorporeal membrane oxygenation (ECMO) for in-hospital cardiac arrest from 2002 to 2011. The primary endpoint was survival to discharge, and the secondary endpoint was long-term functional neurologic status.


RESULTS
Of 160 total uses of cardiac ECMO in 159 patients, 90 (56%) were ECPR (mean age 2.05 years; range, 0 days to 16.5 years). Sixty-four patients (71%) were postoperative, of which 36 were single ventricle and 28 were biventricular. Nine patients (10%) had cardiomyopathy-myocarditis, and 17 patients (19%) were nonpostoperative (5 single ventricle; 12 biventricular). Fifty-nine patients (66%) had open chest cannulation, and 31 (34%) had peripheral cannulation. Fifty patients (56%) survived to discharge. Duration of ECMO was 4.3±4.0 days (median 3) for survivors and 6.3±5.4 days (median 5) for nonsurvivors (p<0.05). On follow-up, almost half of survivors without genetic syndromes had normal neurologic status.


CONCLUSIONS
Extracorporeal cardiopulmonary resuscitation is an appropriate application of ECMO in pediatric cardiac patients. We report overall survival of 56%. Cardiomyopathy patients have favorable outcomes (89% survival). Biventricular patients have better outcomes then single ventricle patients (p<0.01). Extracorporeal cardiopulmonary resuscitation also seems to be a good strategy for nonpostoperative patients (71% survival). Nearly half of postoperative patients (46%) resuscitated with ECPR survived to hospital discharge.
Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia 30322, USA.
Michael J
MJ
Wolf
Kirk R
KR
Kanter
Paul M
PM
Kirshbom
Brian E
BE
Kogon
Scott F
SF
Wagoner
D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome