Published online before print September 24, 2007, doi: 10.1161/CIRCULATIONAHA.106.680678
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(Circulation. 2007;116:1693-1700.)
© 2007 American Heart Association, Inc.
Pediatric Cardiology |
Extracorporeal Membrane Oxygenation to Aid Cardiopulmonary Resuscitation in Infants and Children
From the Department of Cardiology, Children’s Hospital, Boston, and Department of Pediatrics, Harvard Medical School (R.R.T., P.C.L.), Boston, Mass; Extracorporeal Life Support Organization (P.T.R.), Ann Arbor, Mich; Department of Surgery, University of Michigan Health System (R.H.B.), Ann Arbor, Mich; and Department of Pediatrics, Primary Children’s Hospital, University of Utah (S.L.B.), Salt Lake City, Utah.
Correspondence to Ravi R. Thiagarajan, MBBS, MPH, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115. E-mail ravi.thiagarajan{at}cardio.chboston.org
Received November 29, 2006; accepted July 29, 2007.
Background— Extracorporeal membrane oxygenation (ECMO) has been used to support cardiorespiratory function during pediatric cardiopulmonary resuscitation (CPR). We report on outcomes and predictors of in-hospital mortality after ECMO used to support CPR (E-CPR).
Methods and Results— Outcomes for patients aged <18 years using E-CPR were analyzed with data from the Extracorporeal Life Support Organization, and predictors of in-hospital mortality were determined. Of 26 242 ECMO uses reported, 695 (2.6%) were for E-CPR (n=682 patients). Survival to hospital discharge was 38%. In a multivariable model, pre-ECMO factors such as cardiac disease (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.31 to 0.82) and neonatal respiratory disease (OR 0.28, 95% CI 0.12 to 0.66), white race (OR 0.65, 95% CI 0.45 to 0.94), and pre-ECMO arterial blood pH >7.17 (OR 0.50, 95% CI 0.30 to 0.84) were associated with decreased odds of mortality. During ECMO, renal dysfunction (OR 1.89, 95% CI 1.17 to 3.03), pulmonary hemorrhage (OR 2.23, 95% CI 1.11 to 4.50), neurological injury (OR 2.79, 95% CI 1.55 to 5.02), CPR during ECMO (OR 3.06, 95% CI 1.42 to 6.58), and arterial blood pH <7.2 (OR 2.23, 95% CI 1.23 to 4.06) were associated with increased odds of mortality.
Conclusions— ECMO used to support CPR rescued one third of patients in whom death was otherwise certain. Patient diagnosis, absence of severe metabolic acidosis before ECMO support, and uncomplicated ECMO course were associated with improved survival.
CLINICAL PERSPECTIVE
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Circulation 2007 116: 1643.[Extract] [Full Text]
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