Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-28T16:13:01.008Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcomes of paediatric cardiac patients after 30 minutes of cardiopulmonary resuscitation prior to extracorporeal support

Published online by Cambridge University Press:  31 March 2020

Pilar Anton-Martin Open the ORCID record for Pilar Anton-Martin [Opens in a new window] ,
Axel Moreira ,
Paul Kang  and
Michael L. Green
Pilar Anton-Martin*
Affiliation:
Department of Pediatrics, Division of Cardiology, University of Tennessee Health Science Center/Le Bonheur Children’s Hospital, Memphis, TN, USA
Axel Moreira
Affiliation:
Department of Pediatrics, Division of Critical Care, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX, USA
Paul Kang
Affiliation:
Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Phoenix, AZ, USA
Michael L. Green
Affiliation:
Department of Pediatrics, Division of Critical Care, University of Texas Southwestern Medical Center/Children’s Health Children’s Medical Center, Dallas, TX, USA
*
Author for correspondence: P. Anton-Martin, MD, PhD, Department of Pediatrics, Division of Cardiology, University of Tennessee Health Science Center/Le Bonheur Children’s Hospital, Memphis, Tennessee, USA. Tel: +901 604 2811; Fax: +901 287 5970; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To characterise the mortality and neurological outcomes of paediatric cardiac patients requiring cardiopulmonary resuscitation for more than 30 minutes prior to extracorporeal membrane oxygenation cannulation and to identify risk factors associated with adverse outcomes in this population.

Materials and methods:

Observational retrospective cohort study in paediatric cardiac patients undergoing cardiopulmonary resuscitation for greater than 30 minutes prior to cannulation in a tertiary children’s hospital, from July 2000 to July 2013.

Results:

Seventy-three paediatric cardiac patients requiring cardiopulmonary resuscitation for more than 30 minutes prior to cannulation were included in the study. Survival to hospital discharge was 43.8%, with 75% of survivors having either normal neurologic function or only mild disability. Multivariable logistic regression analysis demonstrated that increased use of calcium during resuscitation (odds ratio 14.5, p 0.01), cardiopulmonary resuscitation duration >50 minutes (odds ratio 4.12, p 0.03), >6 interruptions of chest compressions during cannulation (odds ratio 6.40, p 0.03), the need for continuous renal replacement therapy (odds ratio 11.1, p 0.001), and abnormal pupillary response during extracorporeal membrane oxygenation (odds ratio 33.9, p 0.006) were independent predictors for hospital mortality.

Conclusion:

Survival after cardiopulmonary resuscitation for more than 30 minutes prior to extracorporeal membrane oxygenation cannulation in our paediatric cardiac cohort was 43.8%. Factors associated with mortality included calcium use during resuscitation, longer cardiopulmonary resuscitation, increased chest compression pauses during cannulation, the use of continuous renal replacement therapy, and abnormal pupils during extracorporeal membrane oxygenation support. A prospective assessment of these factors in paediatric cardiac patients may be beneficial in improving outcomes.

Keywords

Extracorporeal membrane oxygenationextracorporeal cardiopulmonary resuscitationcardiac arrestcardiopulmonary resuscitationsurvivalneurological outcomes
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 5 , May 2020 , pp. 607 - 616
Copyright
© The Author(s) 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Joffe, AR, Lequier, L, Robertson, CM. Pediatric outcomes after extracorporeal membrane oxygenation for cardiac disease and for cardiac arrest: a review. ASAIO J 2012; 58: 297–310.CrossRefGoogle ScholarPubMed
Morris, MC, Ittenbach, RF, Godinez, RI, et al.Risk factors for mortality in 137 pediatric cardiac intensive care unit patients managed with extracorporeal membrane oxygenation. Crit Care Med 2004; 32: 1061–1069.CrossRefGoogle ScholarPubMed
Thiagarajan, RR, Laussen, PC, Rycus, PT, Bartlett, RH, Bratton, SL. Extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in infants and children. Circulation 2007; 116: 1693–1700.CrossRefGoogle ScholarPubMed
Tajik, M, Cardarelli, MG. Extracorporeal membrane oxygenation after cardiac arrest in children: What do we know? Eur J Cardiothorac Surg 2008; 33: 409–417.CrossRefGoogle ScholarPubMed
Raymond, TT, Cunnyngham, CB, Thompson, MT, et al.; American Heart Association National Registry of CPR Investigators. Outcomes among neonates, infants, and children after extracorporeal cardiopulmonary resuscitation for refractory in-hospital pediatric cardiac arrest: a report from the national registry of cardiopulmonary resuscitation. Pediatr Crit Care Med 2010; 11: 362–371.Google ScholarPubMed
Kane, DA, Thiagarajan, RR, Wypij, D, et al.Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation 2010; 122: S241–S248.CrossRefGoogle ScholarPubMed
De Mos, N, Van Litsenberg, RLR, McCrindle, B, Bohn, DJ, Parshuram, CS. Pediatric in-intensive-care-unit arrest: incidence, survival and predictive factors. Crit Care Med 2006; 34: 1209–1215.CrossRefGoogle ScholarPubMed
Extracorporeal Life Support Organization. ELSO guidelines. Guidelines for ECPR cases. Published December 2013. Retrieved October 1, 2018, from: https://www.elso.org/Portals/0/IGD/Archive/FileManager/6713186745cusersshyerdocumentselsoguidelinesforecprcases1.3.pdfGoogle Scholar
Marino, BS, Tabbutt, S, MacLaren, G, et al.; American Heart Association Congenital Cardiac Defects Committee of the Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Emergency Cardiovascular Care Committee. Cardiopulmonary resuscitation in infants and children with cardiac disease: a scientific statement from the American heart association. Circulation 2018; 137: e691–e782.CrossRefGoogle ScholarPubMed
Lasa, JJ, Rogers, RS, Localio, R, et al.Extracorporeal cardiopulmonary resuscitation (E-CPR) during pediatric in-hospital cardiopulmonary arrest is associated with improved survival to discharge: a report from the American Heart Association’s get with the guidelines-resuscitation (GWTG-R) registry. Circulation 2016; 133: 165–176.CrossRefGoogle ScholarPubMed
Kumar, TK, Zurakowski, D, Dalton, H, et al.Extracorporeal membrane oxygenation in postcardiotomy patients: factors influencing outcome. J Thorac Cardiovasc Surg 2010; 140: 330–336e2.CrossRefGoogle ScholarPubMed
Sivarajan, VB, Best, D, Brizard, CP, Shekerdemian, LS, d’Udekem, Y, Butt, W. Duration of resuscitation prior to rescue extracorporeal membrane oxygenation impacts outcome in children with heart disease. Intensive Care Med 2011; 37: 853–860.CrossRefGoogle ScholarPubMed
Torres-Andres, F, Fink, EL, Bell, MJ, Sharma, MS, Yablonsky, EJ, Sanchez-de-Toledo, J. Survival and long-term functional outcomes for children with cardiac arrest treated with extracorporeal cardiopulmonary resuscitation. Pediatr Crit Care Med 2018; 19: 451–458.CrossRefGoogle ScholarPubMed
Kelly, RB, Porter, PA, Meier, AH, Myers, JL, Thomas, NJ. Duration of cardiopulmonary resuscitation before extracorporeal rescue: how long is not long enough? ASAIO J 2005; 51: 665–667.CrossRefGoogle Scholar
Thiagarajan, R, Brediger, S, Larsen, S, Fynn-Thompson, F, Alexander, P. Extracorporeal cardiopulmonary resuscitation. In: Brogan, T (ed.). Extracorporeal Life Support: The ELSO Red Book, 5th edn. Extracorporeal Life Support Organization, Ann Arbor, MI, 2017: 321–322.Google Scholar
Fiser, DH, Long, N, Roberson, PK, Hefley, G, Zolten, K, Brodie-Fowler, M. Relationship of pediatric overall performance category and pediatric cerebral performance category scores at pediatric intensive care unit discharge with outcome measures collected at hospital discharge and 1- and 6-month follow-up assessments. CritCare Med 2000; 28: 2616–2620.CrossRefGoogle ScholarPubMed
Pollack, MM, Holubkov, R, Funai, T, et al.Relationship between the functional status scale and the pediatric overall performance category and pediatric cerebral performance category scales. JAMA Pediatr 2014; 168: 671–676.CrossRefGoogle ScholarPubMed
Shah, SA, Shankar, V, Churchwell, KB, et al.Clinical outcomes of 84 children with congenital heart disease managed with extracorporeal membrane oxygenation after cardiac surgery. ASAIO J 2005; 51: 504–507.CrossRefGoogle ScholarPubMed
Chan, T, Thiagarajan, RR, Frank, D, Bratton, SL. Survival after extracorporeal cardiopulmonary resuscitation in infants and children with heart disease. J Thorac Cardiovasc Surg 2008; 136: 984–992.CrossRefGoogle ScholarPubMed
Alsoufi, B, Al-Radi, OO, Gruenwald, C, et al.Extra-corporeal life support following cardiac surgery in children: analysis of risk factors and survival in a single institution. Eur J Cardiothorac Surg 2009; 35: 1004–1011.CrossRefGoogle ScholarPubMed
Huang, SC, Wu, ET, Chen, YS, et al.Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients. Crit Care Med 2008; 36: 1607–1613.CrossRefGoogle ScholarPubMed
Erek, E, Aydın, S, Suzan, D, et al.Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in children after cardiac surgery. Anatol J Cardiol 2017; 17: 328–333.Google ScholarPubMed
Philip, J, Burgman, C, Bavare, A, et al.Nature of the underlying heart disease affects survival in pediatric patients undergoing extracorporeal cardiopulmonary resuscitation. J Thorac Cardiovasc Surg 2014; 148: 2367–2372.CrossRefGoogle ScholarPubMed
Guo, Z, Yang, Y, Zhang, W, et al.Extracorporeal cardiopulmonary resuscitation in children after open heart surgery. Artif Organs 2019; 43: 633–640.CrossRefGoogle ScholarPubMed
Allan, CK, Thiagarajan, RR, Armsby, LR, del Nido, PJ, Laussen, PC. Emergent use of extracorporeal membrane oxygenation during pediatric cardiac catheterization. Pediatr Crit Care Med 2006; 7: 212–219.CrossRefGoogle ScholarPubMed
Thourani, VH, Kirshbom, PM, Kanter, KR, et al.Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in pediatric cardiac support. Ann Thorac Surg 2006; 82: 138–144.CrossRefGoogle Scholar
Ghez, O, Fouilloux, V, Charpentier, A, et al.Absence of rapid deployment extracorporeal membrane oxygenation (ECMO) team does not preclude resuscitation ecmo in pediatric cardiac patients with good results. ASAIO J 2007; 53: 692–695.CrossRefGoogle Scholar
Wolf, MJ, Kanter, KR, Kirshbom, PM, Kogon, BE, Wagoner, SF. Extracorporeal cardiopulmonary resuscitation for pediatric cardiac patients. Ann Thorac Surg 2012; 94: 874–879.CrossRefGoogle ScholarPubMed
Polimenakos, AC, Rizzo, V, El-Zein, CF, Ilbawi, MN. Post-cardiotomy rescue extracorporeal cardiopulmonary resuscitation in neonates with single ventricle after intractable cardiac arrest: attrition after hospital discharge and predictors of outcome. Pediatr Cardiol 2017; 38: 314–323.CrossRefGoogle ScholarPubMed
Shakoor, A, Pedroso, FE, Jacobs, SE, Okochi, S, Zenilman, A, Cheung, EW, Middlesworth, W. Extracorporeal cardiopulmonary resuscitation (ECPR) in infants and children: a single-center retrospective study. World J Pediatr Congenit Heart Surg 2019; 10: 582–589.CrossRefGoogle ScholarPubMed
Matos, RI, Watson, RS, Nadkarni, VM, et al; American Heart Association’s Get With The Guidelines–Resuscitation (Formerly the National Registry of Cardiopulmonary Resuscitation) Investigators. Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests. Circulation 2013; 127: 442–451.CrossRefGoogle ScholarPubMed
Ortmann, L, Prodhan, P, Gossett, J, et al; American Heart Association’s Get With the Guidelines–Resuscitation Investigators. Outcomes after in-hospital cardiac arrest in children with cardiac disease: a report from get with the guidelines--resuscitation. Circulation 2012; 124: 2329–2337.CrossRefGoogle Scholar
Conrad, SA, Rycus, PT. Extracorporeal membrane oxygenation for refractory cardiac arrest. Ann Card Anaesth 2017; 20: S4–S10.CrossRefGoogle ScholarPubMed
Atkins, DL, Berger, S, Duff, JP, et al.; Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015. American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015; 132: S519–S525.CrossRefGoogle ScholarPubMed
Christenson, J, Andrusiek, D, Everson-Stewart, S, et al.; Resuscitation Outcomes Consortium Investigators. Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation 2009; 120: 1241–1247.CrossRefGoogle ScholarPubMed
Gundersen, K, Kvaløy, JT, Kramer-Johansen, J, Steen, PA, Eftestøl, T. Development of the probability of return of spontaneous circulation in intervals without chest compressions during out-of-hospital cardiac arrest: an observational study. BMC Med 2009; 6: 6–7.CrossRefGoogle Scholar
Kimura, S, Iwasaki, T, Oe, K, et al.High ionized calcium concentration is associated with prolonged length of stay in the intensive care unit for postoperative pediatric cardiac patients. J Cardiothorac Vasc Anesth 2018; 32: 1667–1675.CrossRefGoogle ScholarPubMed
Srinivasan, V, Morris, MC, Helfaer, MA, Berg, RA, Nadkarni, VM; American Heart Association National Registry of CPR Investigators. Calcium use during in-hospital pediatric cardiopulmonary resuscitation: a report from the national registry of cardiopulmonary resuscitation. Pediatrics 2008; 121: e1144–e1151.CrossRefGoogle ScholarPubMed
Supplementary material: File

Anton-Martin et al. supplementary material

Anton-Martin et al. supplementary material

Download Anton-Martin et al. supplementary material(File)
File 24.4 KB