Results of Extracorporeal Cardiopulmonary Resuscitation in Children

• Main Authors: Hong Ju Shin, Seunghwan Song, Han Ki Park, Young Hwan Park
• Format: Article
• Language: English
• Published: Korean Society for Thoracic and Cardiovascular Surgery 2016-06-01
• Series: Korean Journal of Thoracic and Cardiovascular Surgery
• Subjects: Extracorporeal cardiopulmonary resuscitation; Child; Cardiopulmonary bypass; Resuscitation
• Online Access: http://www.kjtcvs.org/journal/download_pdf.php?doi=10.5090/kjtcs.2016.49.3.151

Background: Survival of children experiencing cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest. Methods: Patients who were ＜18 years and underwent ECPR between November 2013 and January 2016 were including in this study. We retrospectively investigated patient medical records. Results: Twelve children, median age 6.6 months (range, 1 day to 11.7 years), required ECPR. patients’ diseases spanned several categories: congenital heart disease (n=5), myocarditis (n=2), respiratory failure (n=2), septic shock (n=1), trauma (n=1), and post-cardiotomy arrest (n=1). Cannulation sites included the neck (n=8), chest (n=3), and neck to chest conversion (n=1). Median duration of extracorporeal membrane oxygenation was five days (range, 0 to 14 days). Extracorporeal membrane oxygenation was successfully discontinued in 10 (83.3%) patients. Nine patients (75%) survived more than seven days after support discontinuation and four patients (33.3%) survived and were discharged. Causes of death included ischemic brain injury (n=4), sepsis (n=3), and gastrointestinal bleeding (n=1). Conclusion: ECPR plays a valuable role in children experiencing refractory cardiac arrest. The weaning rate is acceptable; however, survival is related to other organ dysfunction and the severity of ischemic brain injury. ECPR prior to the emergence of end-organ injury and prevention of neurologic injury might enhance survival.