title: Post-cardiotomy Rescue Extracorporeal Cardiopulmonary Resuscitation in Neonates with Single Ventricle After Intractable Cardiac Arrest: Attrition After Hospital Discharge and Predictors of Outcome.
abstract: Extracorporeal cardiopulmonary resuscitation (ECPR) in children with cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) has been reported with encouraging results. We reviewed outcomes of neonates with functional single ventricle (FSV) surviving post-cardiotomy ECPR after hospital discharge. Fifty-eight patients who required post-cardiotomy extracorporeal membrane oxygenation (ECMO) since the introduction of our ECPR protocol (January 2007-December 2011) were identified. Forty-one were neonates. Survival analysis was conducted. Of 41 neonates receiving post-cardiotomy ECMO, 32 had FSV. Twenty-one had ECPR. Fourteen underwent Norwood operation (NO) for hypoplastic left heart syndrome (HLHS). Seven had non-HLHS FSV. Four (of 7) underwent modified NO/DKS with systemic-to-pulmonary shunt (SPS), 2 SPS only and 1 SPS with anomalous pulmonary venous connection repair. Mean age was 6.8 ± 2.1 days. ECMO median duration was 7 days [interquartile range (IQR25-75: 4-18)]. Survival to ECMO discontinuation was 72% (15 of 21 patients) and at hospital discharge 62% (13 of 21 patients). The most common cause of late attrition was cardiac. At last follow-up (median: 22 months; IQR25-75: 3-36), 47% of patients were alive. Duration of ECMO and failure of lactate clearance within 24 h from ECMO deployment determined late survival after hospital discharge (p < 0.05). Rescue post-cardiotomy ECMO support in neonates with FSV carries significant late attrition. ECMO duration and failure in lactate clearance after deployment are associated with unfavorable outcome. Emphasis on CPR quality, refinement of management directives early during ECMO and aggressive early identification of patients requiring heart transplantation might improve late survival.
authors.affiliation: Division of Pediatric Cardiovascular Surgery, Advocate Hope Children's Hospital, Oak Lawn, IL, USA. anapolisis@aol.com.|Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Georgia Heart Center, Medical College of Georgia, 1120 15th Street BAA 8300, Augusta, GA, 30912, USA. anapolisis@aol.com.
authors.forename: Anastasios C
authors.initials: AC
authors.lastname: Polimenakos
authors.affiliation: Division of Pediatric Cardiovascular Surgery, Advocate Hope Children's Hospital, Oak Lawn, IL, USA.
authors.forename: Vincent
authors.initials: V
authors.lastname: Rizzo
authors.affiliation: Division of Pediatric Cardiovascular Surgery, Advocate Hope Children's Hospital, Oak Lawn, IL, USA.
authors.forename: Chawki F
authors.initials: CF
authors.lastname: El-Zein
authors.affiliation: Division of Pediatric Cardiovascular Surgery, Advocate Hope Children's Hospital, Oak Lawn, IL, USA.
authors.forename: Michel N
authors.initials: MN
authors.lastname: Ilbawi
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D058327:Norwood Procedures / Q000009:adverse effects*; D010351:Patient Discharge; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Cardiac arrest; Extracorporeal cardiopulmonary support; Single ventricle physiology