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Extracorporeal membrane oxygenator rescue in children during cardiac arrest after cardiac surgery
P J del Nido1, H J Dalton, A E Thompson
1Department of Surgery, University of Pittsburgh School of Medicine, PA.
Insights
Extracorporeal membrane oxygenation (ECMO) offers a feasible rescue therapy for children experiencing cardiac arrest after open-heart surgery, even after prolonged cardiopulmonary resuscitation (CPR). This mechanical support shows promising survival rates in selected pediatric patients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Conventional cardiopulmonary resuscitation (CPR) is often unsuccessful for pediatric cardiac arrest post-open-heart surgery.
- Open-chest massage may not be sufficient in these critical cases.
Purpose of the Study:
- To review the effectiveness of mechanical support as rescue therapy for children with circulatory arrest after cardiac surgery.
- Evaluate outcomes of extracorporeal membrane oxygenation (ECMO) in this patient population.
Main Methods:
- Utilized extracorporeal membrane oxygenator (ECMO) circuits for mechanical cardiac support in 33 children from 1981-1991.
- Focused on 11 patients who experienced cardiac arrest intractable to conventional CPR after open-heart procedures.
Main Results:
- ECMO was initiated after a mean CPR duration of 65 minutes and continued for 112 hours.
- Early survival was 64% (7 of 11 patients), with one requiring heart transplantation.
- Causes of mortality included neurological complications and cardiac dysfunction; sepsis occurred in one survivor.
Conclusions:
- ECMO is a feasible rescue option for selected pediatric patients with postcardiotomy cardiac arrest.
- Successful application is possible even after extended periods of CPR (up to 60 minutes).
- No long-term sequelae were observed in surviving patients.
Background:
Conventional cardiopulmonary resuscitation (CPR) for cardiac arrest after open-heart surgery in children is often unsuccessful despite the ability to perform open-chest massage. The purpose of this study was to review our results with mechanical support as rescue therapy in children with sudden circulatory arrest after cardiac surgery.
Methods And Results:
From 1981 through 1991, we have used mechanical support with an extracorporeal membrane oxygenator (ECMO) circuit for cardiac support in 33 children. Eleven of the 33 patients (age, 15 +/- 7 months) suffered cardiac arrest intractable to conventional open-chest massage 39 +/- 15 hours after an open-heart procedure. The mean duration of CPR was 65 +/- 9 minutes until ECMO flow was started. ECMO support was continued for 112 +/- 8 hours. One patient had ECMO discontinued due to bleeding (survived); three were discontinued from ECMO and died from neurological complications; and one died of cardiac dysfunction. Sepsis on ECMO was seen in one patient (survived). Overall early survival was seven of 11 (64%) with one patient requiring heart transplantation due to irreversible cardiac dysfunction. One child died late (1 month) after ECMO support. There were no long-term sequelae in the survivors.
Conclusions:
We conclude that ECMO rescue in children with postcardiotomy cardiac arrest is a feasible option in selected patients even after prolonged CPR (as long as 60 minutes).
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