Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unit |
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| Authors: | Parthak Prodhan Richard T Fiser Umesh Dyamenahalli Jeffrey Gossett Michiaki Imamura Robert DB Jaquiss Adnan T Bhutta |
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| Institution: | 1. Pediatric Critical Care Medicine, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children''s Hospital, Little Rock, AR 72205, United States;2. Pediatric Cardiology, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children''s Hospital, Little Rock, AR 72205, United States;3. Pediatric Cardiothoracic Surgery, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children''s Hospital, Little Rock, AR 72205, United States;4. Biostatistics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children''s Hospital, Little Rock, AR 72205, United States;1. University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble F-38041, France;2. Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, France;3. Department of Anesthesiology and Critical Care, University Hospital of Grenoble Alps, France;4. Department of Cardiology, University Hospital of Grenoble Alps, Grenoble, France;5. Department of Cardiac Surgery, University Hospital of Grenoble Alps, Grenoble, France;6. HP2 Laboratory, INSERM U 1042, Grenoble, France;7. University Grenoble Alps, Grenoble Institut des Neurosciences, Grenoble F-38042, France;8. Quality of Care Unit, INSERM CIC1406, University Hospital of Grenoble Alps, Grenoble, France;1. Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Prahran, Melbourne, Australia;2. Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hopital de la Pitié—Salpetrière, Assistance Publique—Hôpitaux de Paris, Université Pierre et Marie Curie, 47-83 bd de l’Hopital, Paris 75651, France;3. Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia;4. Extracorporeal Life Support Organization, Ann Arbor, MI, USA;1. Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, Bygning J, Plan 1, 8200 Aarhus N, Denmark;2. Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA;3. Medical Intensive Care Unit, Assistance Publique Hôpitaux de Paris, Ambroise Paré Hospital, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France;4. Versailles Saint Quentin University, INSERM UMR1018, Team 5 Kidney & Heart, 78000 Versailles, France;5. Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark;6. Department of Critical Care Medicine, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1X8, Canada;7. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA;8. Bristol Medical School, University of Bristol, 69 St Michael’s Hill, Bristol BS2 8DZ, UK;9. NIHR Southampton Respiratory Biomedical Research Unit, Southampton, SO16 6YD, UK;1. Canadian National Transplant Research Program, Canada;2. Research Institute McGill University Health Centre, Montréal, Canada;3. Centre de Prélèvement d’Organes and Laboratoire de Simulation, Hôpital du Sacré-C?ur, Montréal, Canada;4. Faculty of Medicine and Health Sciences, Universidad de Alcalá de Henares, Madrid, Spain;5. Helicopter Emergency Medical Service (SUMMA 112), Madrid, Spain;6. DePPaRT Study, Pediatric Critical Care, Children''s Hospital of Eastern Ontario Research Institute, Ottawa, Canada;7. Deceased Donation, Canadian Blood Services, Ottawa, Canada;8. Division of Critical Care, Montreal Children''s Hospital, McGill University Health Centre, Montreal, Canada;9. McGill University, Montreal, Canada;10. Royal College of Physicians and Surgeons of Canada, Canada;11. Medical Library, McConnell Resource Centre, McGill University Health Centre, Montreal, Canada;1. Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan;2. Department of Cardiothoracic Surgery, Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan;3. Department of Neuropsychology, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland;4. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland;5. Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland;6. Department of Pediatric Rehabilitation Medicine, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland;7. Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland;8. Department of Pediatrics, University of Utah, Salt Lake City, Utah;9. Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan;1. SAMU de Paris and intensive care unit, Necker Hospital, Assistance Publique-Hopitaux de Paris (APHP), 149 rue de de Sevres 75015 Paris, France;2. Paris Sudden Death Expertise Center, Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France;3. Inserm, U955, Equipe 03, F94000 Créteil, France;4. Cardiology Department, European Georges Pompidou Hospital, Assistance Publique-Hopitaux de Paris (APHP), 20-40 rue Leblanc, 75908 Paris Cedex 15, France;5. Universite, Paris Descartes-Sorbonne Paris Cite, Paris, France;6. Cardio-surgery Department, European Georges Pompidou Hospital, Assistance Publique-Hopitaux de Paris (APHP), 20-40 rue Leblanc, 75908 Paris Cedex 15, France;7. SAMU 97-1, CHU Pointe à Pitre/Abymes, route de Chauvel, 97159 Pointe à Pitre cedex, Guadeloupe, France;8. Emergency departement, Cochin hospital, Assistance Publique-Hopitaux de Paris (APHP) Paris France;9. Brigade des Sapeurs-Pompiers de Paris, Paris, France |
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| Abstract: | AimTo describe our experience using extracorporeal cardiopulmonary resuscitation (ECPR) in resuscitating children with refractory cardiac arrest in the intensive care unit (ICU) and to describe hospital survival and neurologic outcomes after ECPR.MethodsA retrospective chart review of a consecutive case series of patients requiring ECPR from 2001 to 2006 at Arkansas Children's Hospital. Data from medical records was abstracted and reviewed. Primary study outcomes were survival to hospital discharge and neurological outcome at hospital discharge.ResultsDuring the 6-year study period, ECPR was deployed 34 times in 32 patients. 24 deployments (73%) resulted in survival to hospital discharge. Twenty-eight deployments (82%) were for underlying cardiac disease, 3 for neonatal non-cardiac (NICU) patients and 3 for paediatric non-cardiac (PICU) patients. On multivariate logistic regression analysis, only serum ALT (p-value = 0.043; OR, 1.6; 95% confidence interval, 1.014–2.527) was significantly associated with risk of death prior to hospital discharge. Blood lactate at 24 h post-ECPR showed a trend towards significance (p-value = 0.059; OR, 1.27; 95% confidence interval, 0.991–1.627). The Hosmer–Lemeshow tests (p-value = 0.178) suggested a good fit for the model. Neurological evaluation of the survivors revealed that there was no change in PCPC scores from a baseline of 1–2 in 18/24 (75%) survivors.ConclusionsECPR can be used successfully to resuscitate children following refractory cardiac arrest in the ICU, and grossly intact neurologic outcomes can be achieved in a majority of cases. |
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