Joseph Philip1, Cole Burgman2, Aarti Bavare3, Ayse Akcan-Arikan3, Jack F Price4, Iki Adachi5, Lara S Shekerdemian6. 1. Congenital Heart Center, Shands Children's Hospital, University of Florida, Gainsville, Fla. 2. Section of Critical Care and Congenital Heart Surgery, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex. 3. Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex. 4. Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex. 5. Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine, Houston, Tex. 6. Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Critical Care, Texas Section of Children's Hospital, Houston, Tex. Electronic address: lssheker@texaschildrens.org.
Abstract
OBJECTIVE: To describe the use of extracorporeal membrane oxygenation (ECMO) in acute resuscitation after cardiac arrest in pediatric patients with heart disease, with reference to patient selection and predictors of outcome. METHODS: A retrospective medical record review was performed of all patients aged ≤21 years with heart disease who had undergone ECMO for cardiopulmonary resuscitation (ECPR) at Texas Children's Hospital from January 2005 to December 2012. The most recent Pediatric Overall Performance Category score was determined from the patients' medical records. RESULTS: During the study period, 62 episodes of ECPR occurred in 59 patients, with 27 (46%) surviving to hospital discharge and 25 (43%) alive at the most recent follow-up visit. The overall survival to discharge for patients with myocardial failure (myocarditis, cardiomyopathy, or after transplantation) and structural heart disease was similar (40% vs 50%, P=.6). No patient with restrictive cardiomyopathy survived; 1 patient (13%) in ECPR group after late cardiac graft failure survived to discharge. Survival to discharge was greater for patients who were intubated (70%) at cardiac arrest (P=.001). The presence of pre-existing acute kidney injury at cardiac arrest (62%) was associated with greater mortality (P=.059). A Pediatric Overall Performance Category score of ≤2 (indicating good neurologic performance) was present in 68% of the survivors; 7 patients (87%) with a score>2 had abnormal imaging findings (P=.01). CONCLUSIONS: ECPR was associated with modest survival in pediatric patients with heart disease; however, this was associated in part with the underlying disease and pre-existing comorbidities, including the presence of acute kidney injury.
OBJECTIVE: To describe the use of extracorporeal membrane oxygenation (ECMO) in acute resuscitation after cardiac arrest in pediatric patients with heart disease, with reference to patient selection and predictors of outcome. METHODS: A retrospective medical record review was performed of all patients aged ≤21 years with heart disease who had undergone ECMO for cardiopulmonary resuscitation (ECPR) at Texas Children's Hospital from January 2005 to December 2012. The most recent Pediatric Overall Performance Category score was determined from the patients' medical records. RESULTS: During the study period, 62 episodes of ECPR occurred in 59 patients, with 27 (46%) surviving to hospital discharge and 25 (43%) alive at the most recent follow-up visit. The overall survival to discharge for patients with myocardial failure (myocarditis, cardiomyopathy, or after transplantation) and structural heart disease was similar (40% vs 50%, P=.6). No patient with restrictive cardiomyopathy survived; 1 patient (13%) in ECPR group after late cardiac graft failure survived to discharge. Survival to discharge was greater for patients who were intubated (70%) at cardiac arrest (P=.001). The presence of pre-existing acute kidney injury at cardiac arrest (62%) was associated with greater mortality (P=.059). A Pediatric Overall Performance Category score of ≤2 (indicating good neurologic performance) was present in 68% of the survivors; 7 patients (87%) with a score>2 had abnormal imaging findings (P=.01). CONCLUSIONS: ECPR was associated with modest survival in pediatric patients with heart disease; however, this was associated in part with the underlying disease and pre-existing comorbidities, including the presence of acute kidney injury.
Authors: Javier J Lasa; Parag Jain; Tia T Raymond; Charles G Minard; Alexis Topjian; Vinay Nadkarni; Michael Gaies; Melania Bembea; Paul A Checchia; Lara S Shekerdemian; Ravi Thiagarajan Journal: Pediatr Crit Care Med Date: 2018-02 Impact factor: 3.624
Authors: Kathleen L Meert; Anne-Marie Guerguerian; Ryan Barbaro; Beth S Slomine; James R Christensen; John Berger; Alexis Topjian; Melania Bembea; Sarah Tabbutt; Ericka L Fink; Steven M Schwartz; Vinay M Nadkarni; Russell Telford; J Michael Dean; Frank W Moler Journal: Crit Care Med Date: 2019-03 Impact factor: 7.598