Elsevier

Resuscitation

Volume 83, Issue 6, June 2012, Pages 710-714
Resuscitation

Clinical paper
Eleven years of experience with extracorporeal cardiopulmonary resuscitation for paediatric patients with in-hospital cardiac arrest

https://doi.org/10.1016/j.resuscitation.2012.01.031Get rights and content

Abstract

Purpose

The study aims to describe 11 years of experience with extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital paediatric cardiac arrest in a university affiliated tertiary care hospital.

Methods

Paediatric patients who received extracorporeal membrane oxygenation (ECMO) during active extracorporeal cardiopulmonary resuscitation (ECPR) at our centre from 1999 to 2009 were included in this retrospective study. The results from three different cohorts (1999–2001, 2002–2005 and 2006–2009) were compared. Survival rates and neurological outcomes were analysed. Favourable neurological outcome was defined as paediatric cerebral performance categories (PCPC) 1, 2 and 3.

Results

We identified 54 ECPR events. The survival rate to hospital discharge was 46% (25/54), and 21 (84%) of the survivors had favourable neurological outcomes.

The duration of CPR was 39 ± 17 min in the survivors and 52 ± 45 min in the non-survivors (p = NS). The patients with pure cardiac causes of cardiac arrest had a survival rate similar to patients with non-cardiac causes (47% (18/38) vs. 44% (7/16), p = NS).

The non-survivors had higher serum lactate levels prior to ECPR (13.4 ± 6.4 vs. 8.8 ± 5.1 mmol/L, p < 0.01) and more renal failure after ECPR (66% (19/29) vs. 20% (5/25), p < 0.01).

The patients resuscitated between 2006 and 2009 had shorter durations of CPR (34 ± 13 vs. 78 ± 76 min, p = 0.032) and higher rates of survival (55% (16/29) vs. 0% (0/8), p = 0.017) than those resuscitated between 1999 and 2002.

Conclusions

In our single-centre experience with ECPR for paediatric in-hospital cardiac arrest, the duration of CPR has become shorter and outcomes have improved in recent years. Higher pre-ECPR lactate levels and the presence of post-ECPR renal failure were associated with increased mortality. The presence of non-cardiac causes of cardiac arrest did not preclude successful ECPR outcomes. The duration of CPR was not significantly associated with poor outcomes in this study.

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.

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