Abstract 259: Cardiopulmonary Resuscitation in Infants After Stage One Palliation: The Impact of Shunt Type and Extracorporeal Membrane Oxygenation on Midterm Transplant-Free Survival
Background: The results of cardiopulmonary resuscitation (CPR) after stage one palliation (S1P) have been reported to be poor in small case series. The influences of shunt type and ECMO utilization during CPR (ECPR) among this group on mid-term outcomes have not yet been explored.
Methods: All infants at our institution who underwent a stage one palliation (S1P) from August 2002 through December 2009 (n=245) were included for analysis. Each patient was followed until death, loss to follow-up or June 1, 2010.
Results: Of the 245 infants undergoing S1P, 124 received an initial modified Blalock-Taussig shunt (BTS), while 121 underwent a right ventricle to pulmonary artery conduit (RV-PA). Overall hospital survival for the BTS group was 86% compared to 88% in the RV-PA group (p=0.49). There was no significant difference in the frequency of CPR events between the shunt types; 40 CPR events in 33 BTS patients and 36 events in 24 patients with a RV-PA shunt (p=0.24). There was no difference in the frequency of ECPR between the shunt types; BTS 42% vs. RV-PA 33% (p=0.59). Of those who undergoing CPR, there was no difference in hospital survival between the BTS group (67%) versus the RV-PA group (63%), (p=0.78). Transplant-free survival after S1P for those undergoing at least one CPR event was 43% at 3 years, versus 79% for all others (p<0.001). In multivariable analysis of those undergoing CPR, neither shunt type nor ECPR were found to be independently associated with transplant-free survival through the period of typical Fontan completion, after adjustment for greater than mild pre-operative ventricular dysfunction and atrioventricluar valve regurgitation.
Conclusions: Longitudinal transplant-free survival in those undergoing after CPR after S1P is poor. In a center with an experienced ECMO program, shunt type at S1P is not independently associated with improved hospital survival or mid-term outcomes for those requiring resuscitation.
- © 2010 by American Heart Association, Inc.