title: Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in children after cardiac surgery.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation (ECMO) is used to provide cardiorespiratory support during cardiopulmonary resuscitation (extracorporeal cardiopulmonary resuscitation; ECPR) unresponsive to conventional methods. In this study, the results of ECPR in a cardiac arrest setting after cardiac surgery in children were analyzed.
  
  
  METHODS
  In this retrospective cohort study, between November 2010 and June 2014, 613 congenital heart operations were performed by the same surgical team. Medical records of all the patients who experienced cardiac arrest and ECPR in an early postoperative period (n=25; 4%) were analyzed. Their ages were between 2 days and 4.5 years (median: 3 months). Sixteen patients had palliative procedures. In 88% of the patients, cardiac arrest episodes occurred in the first 24 h after operation. Mechanical support was provided by cardiopulmonary bypass only (n=10) or by ECMO (n=15) during CPR.
  
  
  RESULTS
  The CPR duration until commencing mechanical support was <20 min in two patients, 20-40 min in 11 patients, and >40 min in 12 patients. Eleven patients (44%) were weaned successfully from ECMO and survived more than 7 days. Five of them (20%) could be discharged. The CPR duration before ECMO (p=0.01) and biventricular physiology (p=0.022) was the key factor affecting survival. The follow-up duration was a mean of 15±11.9 months. While four patients were observed to have normal neuromotor development, one patient died of cerebral bleeding 6 months after discharge.
  
  
  CONCLUSIONS
  Postoperative cardiac arrest usually occurs in the first 24 h after operation. ECPR provides a second chance for survival in children who have had cardiac arrest. Shortening the duration of CPR before ECMO might increase survival rates.
authors.affiliation: Department of Cardiovascular Surgery and Pediatric Cardiac Surgery, Acıbadem Atakent Hospital, Medical Faculty, Acıbadem University; İstanbul-Turkey. ersinerek@hotmail.com.
authors.forename: Ersin
authors.initials: E
authors.lastname: Erek
authors.affiliation: Department of Cardiovascular Surgery and Pediatric Cardiac Surgery, Acıbadem Atakent Hospital, Medical Faculty, Acıbadem University; İstanbul-Turkey.
authors.forename: Selim
authors.initials: S
authors.lastname: Aydın
authors.affiliation: Department of Cardiovascular Surgery and Pediatric Cardiac Surgery, Acıbadem Atakent Hospital, Medical Faculty, Acıbadem University; İstanbul-Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Suzan
authors.affiliation: Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; İstanbul-Turkey.
authors.forename: Okan
authors.initials: O
authors.lastname: Yıldız
authors.affiliation: Department of Cardiovascular Surgery and Pediatric Cardiac Surgery, Acıbadem Atakent Hospital, Medical Faculty, Acıbadem University; İstanbul-Turkey.
authors.forename: Fırat
authors.initials: F
authors.lastname: Altın
authors.affiliation: Department of Anesthesiology and Intensive Care, Acıbadem Atakent Hospital, Medical Faculty, Acıbadem University; İstanbul-Turkey.
authors.forename: Barış
authors.initials: B
authors.lastname: Kırat
authors.affiliation: Department of Pediatric Cardiology, Acıbadem Atakent Hospital, Medical Faculty, Acıbadem University; İstanbul-Turkey.
authors.forename: Ibrahim Halil
authors.initials: IH
authors.lastname: Demir
authors.affiliation: Department of Pediatric Cardiology, Acıbadem Atakent Hospital, Medical Faculty, Acıbadem University; İstanbul-Turkey.
authors.forename: Ender
authors.initials: E
authors.lastname: Ödemiş
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016887:Cardiopulmonary Resuscitation; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008499:Medical Records; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D014421:Turkey