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Updated: May 16, 2026
Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
Short- and intermediate-term survival after extracorporeal membrane oxygenation in children with cardiac disease
Constantinos Chrysostomou1, Victor O Morell, Bradley A Kuch
1Department of Critical Care Medicine, Cardiac Intensive Care Unit, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa 15224, USA. chrycx@chp.edu
Insights
Extracorporeal membrane oxygenation (ECMO) in children with cardiac disease shows improved survival rates, with 73% hospital survival. Most survivors achieve normal function or mild neurodevelopmental deficits, indicating successful outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) is a vital treatment for pediatric cardiac patients facing severe cardiopulmonary failure.
- Established indications include refractory cardiopulmonary resuscitation (E-CPR), failure to separate from cardiopulmonary bypass (OR-ECMO), and low cardiac output syndrome (LCOS-ECMO).
- Despite its use, ECMO outcomes remain suboptimal, with reported survival rates between 38% and 55%.
Purpose of the Study:
- To evaluate factors associated with significantly increased survival in pediatric cardiac patients requiring ECMO.
- To identify predictors of mortality and long-term outcomes in this vulnerable population.
Main Methods:
- A retrospective analysis of consecutive pediatric patients undergoing ECMO between 2006 and 2010.
- Inclusion of demographic, pre-ECMO, ECMO, and post-ECMO parameters in the analysis.
- Assessment of neurologic outcomes using the pediatric overall performance category scale at latest follow-up.
Main Results:
- Overall hospital survival was 73%, with survival rates of 75% for E-CPR, 77% for OR-ECMO, and 62% for LCOS-ECMO.
- Multivariable analysis identified chromosomal anomalies, single ventricle, multiple ECMO runs, higher ECMO flows, decreased lung compliance, and need for plasma exchange as mortality predictors.
- Intracranial hemorrhage was a common mortality predictor across all groups.
Conclusions:
- ECMO demonstrated successful application in children with cardiac disease, achieving 73% short-term and 66% intermediate-term survival.
- The majority of ECMO survivors exhibited normal function or only minimal neurodevelopmental deficits.
- These findings highlight the potential for improved outcomes with careful patient selection and management.
Objectives:
In children with cardiac disease, common indications for extracorporeal membrane oxygenation (ECMO) include refractory cardiopulmonary resuscitation (E-CPR), failure to separate from cardiopulmonary bypass (OR-ECMO), and low cardiac output syndrome (LCOS-ECMO). Despite established acceptance, ECMO outcomes are suboptimal with a survival between 38% and 55%. We evaluated factors associated with significantly increased survival in cardiac patients requiring ECMO.
Methods:
We conducted a retrospective investigation of consecutive patients undergoing ECMO between 2006 and 2010. Demographic, pre-ECMO, ECMO, and post-ECMO parameters were analyzed. Neurologic outcomes were assessed with the pediatric overall performance category scale at the latest follow-up.
Results:
There were 3524 admissions, 95 (3%) of which necessitated ECMO; 40 (42%) E-CPR, 31 (33%) OR-ECMO, and 24 (25%) LCOS-ECMO. The overall hospital survival was 73%. The within-groups hospital survival was 75% in E-CPR, 77% OR-ECMO and 62% LCOS-ECMO. In the multivariable logistic regression analysis, chromosomal anomalies (odds ratio [OR], 8; 95% confidence interval [CI], 2-35), single ventricle (OR ,6; 95% CI, 3-33), multiple ECMO runs (OR, 15; 95% CI, 4-42), higher 24-hour ECMO flows (OR, 8; 95% CI, 4-22), decreased lung compliance (OR, 5; 95% CI, 2-16), and need for plasma exchange (OR, 5; 95% CI, 3-18) were all significant factors associated with mortality. From the univariate analysis, a common parameter associated with mortality within all groups was intracranial hemorrhage. At 1.9 years (0.9, 2.9) of follow-up, 66% were still alive, and 89% of survivors had normal function or only mild neurodevelopmental disability.
Conclusions:
ECMO was successfully used in children with cardiac disease with 73% and 66% short- and intermediate-term survival, respectively. The majority of the survivors had normal function or only a minimal neurodevelopmental deficit.
