Özlem SELVİ CAN,
Tanıl KENDİRLİ,
Cağdaş BARAN,
Tayfun UÇAR,
Ercan TUTAR,
Serhan ÖZCAN,
Merve HAVAN,
Mehmet ÇAKICI,
Ahmet Rüçhan AKAR,
Burcu ARICI,
Zeynep EYİLETEN
4522
Pediatric extracorporeal cardiopulmonary resuscitation: single-center study
Pediatric extracorporeal cardiopulmonary resuscitation: single-center study
Background/aim: Extracorporeal cardiopulmonary resuscitation (ECPR) is defined as the venoarterial extracorporeal membrane oxygenation (VA-ECMO) support in a patient who experienced a sudden pulseless condition attributable to cessation of cardiac mechanical activity and circulation. We aimed to evaluate the clinical outcomes of our ECPR experience in a pediatric patient population. Materials and methods: Between September 2014 and November 2017, 15 children were supported with ECPR following in-hospital cardiac arrest (IHCA) in our hospitals. VA-ECMO setting was established for all patients. Pediatric cerebral performance category (PCPC) scales and long-term neurological prognosis of the survivors were assessed. Results: The median age of the study population was 60 (4–156) months. The median weight was 18 (4.8–145) kg, height was 115 (63–172) cm, and body surface area was 0.73 (0.27–2.49) m2 . The cause of cardiac arrest was a cardiac and circulatory failure in 12 patients (80%) and noncardiac causes in 20%. Dysrhythmia was present in 46%, septic shock in 13%, bleeding in 6%, low cardiac output syndrome in 13%, and airway disease in 6% of the study population. Median low-flow time was 95 (range 20–320) min. Central VAECMO cannulation was placed in only 2 (13.3%) cases. However, the return of spontaneous circulation (ROSC) was obtained in 10 (66.6%) patients, and 5 (50%) of them survived. Overall, 5 patients were discharged from the hospital. Finally, survival following ECPR was 33.3%, and all survivors were neurologically intact at hospital-discharge. Conclusion: ECPR can be a life-saving therapeutic strategy using a promising technology in the pediatric IHCA population. Early initiation and a well-coordinated, skilled, and dedicated ECMO team are the mainstay for better survival rates.Key words: Extracorporeal cardiopulmonary resuscitation, extracorporeal membrane oxygenation, children
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- 1. Kramer P, Mommsen A, Miera O, Photiadis J, Berger F et al. Survival and mid-term neurologic outcome after extracorporeal cardiopulmonary resuscitation. Pediatric Critical Care Medicine 2020; 11: 1-9. doi: 10.1097/PCC.0000000000002291
- 2. Holmberg MJ, Geri G, Wiberg S, Guerguerian AM, Donnino MW et al. Extracorporeal cardiopulmonary resuscitation for cardiac arrest: a systematic review. Resuscitation 2018; 131: 91- 100. doi: 10.1016/j.resuscitation.2018.07.029
- 3. Erek E, Aydın S, Suzan D, Yıldız O, Altın F et al. Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in children after cardiac surgery. Anatolian Journal of Cardiology 2017; 17 (4); 328-333. doi: 10.14744/AnatolJCardiol.2016.6658
- 4. Yeşil E, Öztürk NY, İnceköy FG, Ak K. Extracorporeal membrane oxygenation use during active cardiopulmonary resuscitation Journal of Pediatric Emergency and Intensive Care Medicine 2015; 3: 149-152.
- 5. Del Nido PJ. Extracorporeal membrane oxygenation for cardiac support in children. Annals of Thoracic Surgery 1996; 61 (1): 336-339. doi: 10.1016/0003-4975(95)01019-X
- 6. Wolf MJ, Kanter KR, Kirshbom PM, Kogon BE, Wagoner SF. Extracorporeal cardiopulmonary resuscitation for pediatric cardiac patients. Annals of Thoracic Surgery 2012; 94 (3): 874- 880. doi: 10.1016/j.athoracsur.2012.04.040
- 7. Fiser DH, Long N, Roberson PK, Hefley G, Zolten K et al. Relationship of pediatric overall performance category and pediatric cerebral performance category scores at pediatric intensive care unit discharge with outcome measures collected at hospital discharge and 1- and 6-month follow-up assessments. Critical Care Medicine 2000; 28 (7): 2616-2620.
- 8. Kelly RB, Harrison RE. Outcome predictors of pediatric extracorporeal 160 cardiopulmonary resuscitation. Pediatric Cardiology 2010; 31 (5): 626-633. doi: 10.1007/s00246- 161 010-9659-z
- 9. Tsukahara K, Toida C, Muguruma T. Current experience and limitations of extracorporeal cardiopulmonary resuscitation for cardiac arrest in children: a single-center retrospective study. Journal of Intensive Care 2014; 2 (1): 68 doi:10.1186/ s40560-014-0068-x
- 10. Huang SC, Wu ET, Chen YS, Chang CI, Chiu IS et al. Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients. Critical Care Medicine 2008; 36 (5): 1607-1613.
- 11. Alsoufi B, Al-Radi OO, Nazer RI, Gruenwald C, Foreman C et al. Survival outcomes after rescue extracorporeal cardiopulmonary resuscitation in pediatric patients with refractory cardiac arrest. Journal of Thoracic and Cardiovascular Surgery 2007; 134 (4): 952-959.