Nature of the underlying heart disease affects survival in pediatric patients undergoing extracorporeal cardiopulmonary resuscitation.
OBJECTIVE
To describe the use of extracorporeal membrane oxygenation (ECMO) in acute resuscitation after cardiac arrest in pediatric patients with heart disease, with reference to patient selection and predictors of outcome.


METHODS
A retrospective medical record review was performed of all patients aged ≤21 years with heart disease who had undergone ECMO for cardiopulmonary resuscitation (ECPR) at Texas Children's Hospital from January 2005 to December 2012. The most recent Pediatric Overall Performance Category score was determined from the patients' medical records.


RESULTS
During the study period, 62 episodes of ECPR occurred in 59 patients, with 27 (46%) surviving to hospital discharge and 25 (43%) alive at the most recent follow-up visit. The overall survival to discharge for patients with myocardial failure (myocarditis, cardiomyopathy, or after transplantation) and structural heart disease was similar (40% vs 50%, P=.6). No patient with restrictive cardiomyopathy survived; 1 patient (13%) in ECPR group after late cardiac graft failure survived to discharge. Survival to discharge was greater for patients who were intubated (70%) at cardiac arrest (P=.001). The presence of pre-existing acute kidney injury at cardiac arrest (62%) was associated with greater mortality (P=.059). A Pediatric Overall Performance Category score of ≤2 (indicating good neurologic performance) was present in 68% of the survivors; 7 patients (87%) with a score>2 had abnormal imaging findings (P=.01).


CONCLUSIONS
ECPR was associated with modest survival in pediatric patients with heart disease; however, this was associated in part with the underlying disease and pre-existing comorbidities, including the presence of acute kidney injury.
Congenital Heart Center, Shands Children's Hospital, University of Florida, Gainsville, Fla.
Joseph
J
Philip
Section of Critical Care and Congenital Heart Surgery, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
Cole
C
Burgman
Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
Aarti
A
Bavare
Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
Ayse
A
Akcan-Arikan
Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
Jack F
JF
Price
Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine, Houston, Tex.
Iki
I
Adachi
Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Critical Care, Texas Section of Children's Hospital, Houston, Tex. Electronic address: lssheker@texaschildrens.org.
Lara S
LS
Shekerdemian
D058186:Acute Kidney Injury / Q000401:mortality; D000367:Age Factors; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome