title: Comparative Review of Outcomes in Patients With Congenital Heart Disease Requiring Cardiopulmonary Support for Failure to Wean From Cardiopulmonary Bypass or for Refractory Sudden Cardiac Arrest.
abstract: BACKGROUND
  We reviewed the outcomes of patients who underwent cardiopulmonary support (CPS) for either refractory sudden cardiac arrest or failure to wean from cardiopulmonary bypass (CPB).
  
  
  METHODS
  Between January 2005 and July 2013, 37 patients with congenital heart disease (CHD) underwent 39 instances of CPS for sudden cardiac arrest as extracorporeal cardiopulmonary resuscitation (E-CPR; group I, n = 19) or for failure to wean from CPB (group II, n = 20). Univariate analyses determined which variables differed among the groups and which had significant association with hospital survival. Binary logistic regression determined the significant associations in a multivariable model.
  
  
  RESULTS
  Overall 30-day and hospital survival were 76.9% (30) and 69.2% (27), respectively. For groups I and II, hospital survival was 68.4% (13) and 70.0% (14), respectively. Variables associated with mortality in the univariate analysis included hours on CPS (P = .045), initial aspartate aminotransferase (AST) level on CPS (P = .007), and bicarbonate 24 hours on CPS (P = .004). Logistic regression showed single-ventricle physiology (P = .05), initial AST level on CPS (P = .03), and lower bicarbonate 24 hours on CPS (P = .026) to be significantly associated with mortality.
  
  
  CONCLUSIONS
  Comparable rates of survival to discharge can be obtained when CPS is initiated for E-CPR or for failure to wean from CPB in resuscitating patients with CHD. Hepatic and renal factors indicative of inadequate early tissue perfusion, single-ventricle physiology, and lower bicarbonate level are factors associated with poor outcome.
authors.affiliation: The Heart Center at Arnold Palmer Hospital for Children, Orlando, FL, USA The University of Central Florida College of Medicine, Orlando, FL, USA kamal.pourmoghadam@orlandohealth.com.
authors.forename: Kamal K
authors.initials: KK
authors.lastname: Pourmoghadam
authors.affiliation: The Heart Center at Arnold Palmer Hospital for Children, Orlando, FL, USA.
authors.forename: Monica C
authors.initials: MC
authors.lastname: Olsen
authors.affiliation: The Heart Center at Arnold Palmer Hospital for Children, Orlando, FL, USA.
authors.forename: Moui
authors.initials: M
authors.lastname: Nguyen
authors.affiliation: The Heart Center at Arnold Palmer Hospital for Children, Orlando, FL, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: O'Brien
authors.affiliation: The Heart Center at Arnold Palmer Hospital for Children, Orlando, FL, USA The University of Central Florida College of Medicine, Orlando, FL, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: DeCampli
mesh_terms: D002315:Cardiopulmonary Bypass / Q000401:mortality*; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D004812:Epidemiologic Methods; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D016896:Treatment Outcome
keywords: ECMO (extracorporeal membrane oxygenation); congenital heart disease (CHD); congenital heart surgery; heart failure