Rescue extracorporeal membrane oxygenation in children with refractory cardiac arrest

Area of Science:

• Pediatric Critical Care Medicine
• Cardiovascular Surgery
• Extracorporeal Life Support

Background:

• Refractory cardiac arrest in children presents a significant therapeutic challenge.
• Extracorporeal membrane oxygenation (ECMO) offers a potential rescue therapy for refractory cardiac arrest.
• Limited data exists on predictors of mortality in pediatric patients undergoing extracorporeal CPR (ECPR).

Purpose of the Study:

• To describe the experience with extracorporeal CPR using ECMO in children with refractory cardiac arrest.
• To identify predictors of mortality in this pediatric population.

Main Methods:

• Retrospective review of 42 children who received ECMO for refractory cardiac arrest between 1992 and 2008.
• Data collected included patient demographics, diagnosis, cannulation site, CPR duration, and inotropic support.
• Statistical analysis to determine predictors of mortality.

Main Results:

• ECMO was initiated in 42 children (median age 0.7 years) with various underlying conditions including postcardiotomy, congenital heart disease, and trauma.
• Successful discontinuation of ECMO was achieved in 17 patients.
• Neurological injury was the primary cause of mortality.
• Pre-ECMO CPR duration (mean 35±1.3 min for survivors vs. 46±4.2 min for non-survivors) and high-dose inotropes were significant predictors of mortality.
• Age, weight, sex, diagnosis, and etiology were not significant predictors.

Conclusions:

• Rescue ECMO for pediatric refractory cardiac arrest can lead to acceptable survival and neurological outcomes.
• Prolonged CPR duration and the need for high-dose inotropes are critical indicators for poor prognosis.
• ECMO is a viable option for refractory cardiac arrest in children, but careful patient selection and management are crucial.