Clinical paperEleven years of experience with extracorporeal cardiopulmonary resuscitation for paediatric patients with in-hospital cardiac arrest☆
Section snippets
Study population
The Institutional Review Board of National Taiwan University Hospital approved the study. In our institution, data from all ECMO patients, including diagnosis, indication for ECMO, treatment course and outcomes have been prospectively collected for quality assurance since 1999. Data from paediatric patients (age < 18 years) who were cannulated for ECMO during active CPR between January 1999 and December 2009 were retrieved from our database for this study. Patients who were cannulated for ECMO
Patient profiles
There were 54 patients (37 males and 17 females). The mean age was 5.2 ± 5.9 years-old. Twenty-four patients (44%) were infants. All patients experienced their cardiac arrest event in the ICU, except for one patient who experienced cardiac arrest in the emergency department. After ECMO cannulation, 89% (48/54) of the patients survived more than 24 h. Two-thirds (37/54, 68%) of the patients were successfully weaned from ECMO, and the overall survival to hospital discharge was 46% (25/54). The
Discussion
This study showed that the application of ECPR for paediatric in-hospital cardiac arrest could achieve an overall survival rate of 46% and favourable neurological outcomes in 39% of all victims.
The results of ECPR vary in different studies. The largest single-centre series (n = 180) was reported by Kane and colleagues.16 They reported that the overall survival rate to hospital discharge was 52% over a 14-year period. In a recent National Registry of in-hospital cardiopulmonary resuscitation
Conclusions
In our 11 years of in-hospital ECPR experience, many children were successfully resuscitated who otherwise were refractory to conventional CPR. Favourable neurological outcomes were achieved in the majority of the survivors. Higher pre-ECPR lactate levels and the presence of post-ECPR renal failure were associated with increased mortality. Non-cardiac causes of cardiac arrest did not preclude successful outcomes from ECPR, and the duration of CPR was not significantly associated with poorer
Conflicts of interest
Dr. Ko and Dr. Chen have received honoraria/speaking fees from Medtronic. The remaining authors have not disclosed any potential conflicts of interest.
Acknowledgements
We thank Dr. Fu-Chang Hu for his help in the statistical analysis of the data.
This study was supported in part by grant NTUH 98M1200 from the National Taiwan University Hospital and grant NSC 98-2314-B-002-039-MY2 from the National Science Council, Taiwan.
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2012.01.031.