Published Online
on September 24, 2007

A more recent version of this article appeared on October 9, 2007

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Submitted on November 29, 2006
Accepted on July 29, 2007

Extracorporeal Membrane Oxygenation to Aid Cardiopulmonary Resuscitation in Infants and Children

Ravi R. Thiagarajan MBBS, MPH^*, Peter C. Laussen MBBS, Peter T. Rycus MPH, Robert H. Bartlett MD, and Susan L. Bratton MD, MPH

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.

^* To whom correspondence should be addressed. E-mail: ravi.thiagarajan{at}cardio.chboston.org.

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.

Key words: cardiopulmonary resuscitation • extracorporeal circulation • heart arrest • pediatrics

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