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Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
Extracorporeal circulation for rewarming in drowning and near-drowning pediatric patients
Kasim Oguz Coskun1, Aron Frederik Popov, Jan Dieter Schmitto
1Department of Thoracic and CardiovascularSurgery, University of Göttingen, Göttingen, Germany. dr_coskunok@yahoo.de
Insights
Severe hypothermia from drowning requires active rewarming. Cardiopulmonary bypass (CPB) offers efficient rewarming and circulatory support for children, though long-term outcomes are impacted by complications.
Area of Science:
- Pediatric Emergency Medicine
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Drowning and near-drowning incidents frequently result in severe hypothermia, necessitating aggressive core rewarming strategies.
- Traditional rewarming methods can be insufficient for profound hypothermia, highlighting the need for advanced interventions.
Purpose of the Study:
- To evaluate the efficacy and outcomes of rewarming pediatric patients with accidental hypothermia using cardiopulmonary bypass (CPB).
- To assess the impact of CPB-assisted rewarming on survival and long-term neurological status in children following drowning incidents.
Main Methods:
- A retrospective analysis of 13 pediatric patients (average age 3.2 years) with accidental hypothermia (core temperature 20-29°C) who underwent rewarming via extracorporeal circulation (ECC), primarily CPB.
- Resuscitation and ventilation were initiated immediately upon rescue and continued during transport. CPB was established via thoracic or femoral/iliac access.
Main Results:
- Restoration of circulation was achieved in 11 out of 13 patients (84.6%).
- Two patients required extracorporeal membrane oxygenation (ECMO) post-CPB due to severe pulmonary edema.
- Five patients were discharged after extended hospitalization; two died from pulmonary complications, and one was lost to follow-up. Two survivors had no neurological deficits.
Conclusions:
- Rewarming by extracorporeal circulation (ECC) provides effective core rewarming and essential circulatory support in pediatric drowning-related hypothermia.
- While ECC improves immediate survival rates, long-term outcomes remain a concern due to potential pulmonary and neurological complications.
- Factors such as rewarming method, age, sex, initial temperature, and electrolytes did not significantly influence mortality in this cohort.
Abstract:
Drowning and near-drowning is often associated with severe hypothermia requiring active core rewarming.We performed rewarming by cardiopulmonary bypass(CPB). Between 1987 and 2007, 13 children (9 boys and 4 girls) with accidental hypothermia were rewarmed by extracorporeal circulation (ECC) in our institution. The average age of the patients was 3.2 years. Resuscitation was started immediately upon the arrival of the rescue team and was continuously performed during the transportation.All patients were intubated and ventilated. Core temperature at admission ranged from 20 to 29°C (mean 25.3°C). Connection to the CPB was performed by thoracic (9 patients) or femoral/iliac means (4 patients). Restoration of circulation was achieved in 11 patients (84.6%). After CPB termination two patients needed an extracorporeal membrane oxygenation system due to severe pulmonary edema.Five patients were discharged from hospital after prolonged hospital stay. During follow-up, two patients died(10 and 15 months, respectively) of pulmonary complications and one patient was lost to follow-up. The two remaining survivors were without neurological deficit.Modes of rewarming, age, sex, rectal temperature, and serum electrolytes did not influence mortality. In conclusion,drowning and near-drowning with severe hypothermia remains a challenging emergency. Rewarming by ECC provides efficient rewarming and full circulatory support.Although nearly half of the children may survive after rewarming by ECC, long-term outcome is limited by pulmonary and neurological complications.
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