TY - JOUR
T1 - Results of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery
AU - Alsoufi, Bahaaldin
AU - Awan, Abid
AU - Manlhiot, Cedric
AU - Guechef, Alexandr
AU - Al-Halees, Zohair
AU - Al-Ahmadi, Mamdouh
AU - McCrindle, Brian W.
AU - Kalloghlian, Avedis
N1 - Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2014/2
Y1 - 2014/2
N2 - OBJECTIVES: Survival of children having 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 following surgical correction of congenital heart disease. METHODS: Demographic, anatomical, clinical, surgical and support details of children requiring postoperative ECPR (2007-12) were included in multivariable logistic regression models to determine the factors associated with survival. RESULTS: Thirty-nine children, median age 44 days (4 days-10 years), required postoperative ECPR at a median interval of 1 day (up to 15 days) after surgery. Thirteen (33%) children had single-ventricle pathology; Risk Adjustment in Congenital Heart Surgery (RACHS)-1 categories were 2, 3, 4 and 6 in 6, 15, 13 and 5 patients, respectively. Median CPR duration was 34 (8-125) min, while median support duration was 4 (1-17) days. Seven (18%) patients underwent cardiac re-operation, 28 (72%) survived >24 h after support discontinuation and 16 (41%) survived. Survival rates in neonates, infants and older children were 53, 39 and 17% (P = 0.13). Survival rates for single- vs two-ventricle pathology patients were 54 and 35%, (P = 0.25) and 50, 47, 23 and 60% in RACHS-1 2, 3, 4 and 6 patients, respectively (P = 0.37). Survivors had shorter CPR duration (25 vs 34 min, P = 0.05), lower pre-arrest lactate (2.6 vs 4.6 mmol/l, P = 0.05) and postextracorporeal membrane oxygenation (ECMO) peak lactate (15.4 vs 20.0 mmol/l, P < 0.001). On multivariable analysis, factors associated with death were higher immediate post-ECMO lactate (odds ratio, OR 1.34 per mmol/l, P = 0.008) and renal failure requiring haemodialysis (OR 14.1, P = 0.01). CONCLUSIONS: ECPR plays a valuable role in children having refractory postoperative cardiac arrest. Survival is unrelated to cardiac physiology or surgical complexity. Timely support prior to the emergence of end-organ injury and surgical correction of residual cardiac lesions might enhance survival.
AB - OBJECTIVES: Survival of children having 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 following surgical correction of congenital heart disease. METHODS: Demographic, anatomical, clinical, surgical and support details of children requiring postoperative ECPR (2007-12) were included in multivariable logistic regression models to determine the factors associated with survival. RESULTS: Thirty-nine children, median age 44 days (4 days-10 years), required postoperative ECPR at a median interval of 1 day (up to 15 days) after surgery. Thirteen (33%) children had single-ventricle pathology; Risk Adjustment in Congenital Heart Surgery (RACHS)-1 categories were 2, 3, 4 and 6 in 6, 15, 13 and 5 patients, respectively. Median CPR duration was 34 (8-125) min, while median support duration was 4 (1-17) days. Seven (18%) patients underwent cardiac re-operation, 28 (72%) survived >24 h after support discontinuation and 16 (41%) survived. Survival rates in neonates, infants and older children were 53, 39 and 17% (P = 0.13). Survival rates for single- vs two-ventricle pathology patients were 54 and 35%, (P = 0.25) and 50, 47, 23 and 60% in RACHS-1 2, 3, 4 and 6 patients, respectively (P = 0.37). Survivors had shorter CPR duration (25 vs 34 min, P = 0.05), lower pre-arrest lactate (2.6 vs 4.6 mmol/l, P = 0.05) and postextracorporeal membrane oxygenation (ECMO) peak lactate (15.4 vs 20.0 mmol/l, P < 0.001). On multivariable analysis, factors associated with death were higher immediate post-ECMO lactate (odds ratio, OR 1.34 per mmol/l, P = 0.008) and renal failure requiring haemodialysis (OR 14.1, P = 0.01). CONCLUSIONS: ECPR plays a valuable role in children having refractory postoperative cardiac arrest. Survival is unrelated to cardiac physiology or surgical complexity. Timely support prior to the emergence of end-organ injury and surgical correction of residual cardiac lesions might enhance survival.
KW - Cardiac arrest
KW - Congenital heart disease
KW - Extracorporeal life support
KW - Single ventricle
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U2 - 10.1093/ejcts/ezt319
DO - 10.1093/ejcts/ezt319
M3 - Article
C2 - 23818569
AN - SCOPUS:84892512204
SN - 1010-7940
VL - 45
SP - 268
EP - 275
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 2
M1 - ezt319
ER -