Journal of Chest Surgery

  • 제56권3호
  • /
  • Pages.162-170
  • /
  • 2023
  • /
  • 2765-1606(pISSN)
  • /
  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지
DOI QR코드

DOI QR Code

Extracorporeal Cardiopulmonary Resuscitation in Infants: Outcomes and Predictors of Mortality

  • Byeong A Yoo (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seungmo Yoo (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Eun Seok Choi (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Bo Sang Kwon (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chun Soo Park (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Tae-Jin Yun (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Dong-Hee Kim (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2022.11.09
  • 심사 : 2023.01.12
  • 발행 : 2023.05.05
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Extracorporeal cardiopulmonary resuscitation (E-CPR) plays an indispensable role when resuscitation fails; however, extracorporeal life support (ECLS) in infants is different from that in adults. The objective of this study was to evaluate the outcomes of E-CPR in infants. Methods: A single-center retrospective study was conducted, analyzing 51 consecutive patients (age <1 year) who received E-CPR for in-hospital cardiac arrest between 2010 and 2021. Results: The median age and body weight was 51 days (interquartile range [IQR], 17-111 days) and 3.4 kg (IQR, 2.9-5.1 kg), respectively. The cause of arrest was cardiogenic in 45 patients (88.2%), and 48 patients (94.1%) had congenital cardiac anomalies. The median conventional cardiopulmonary resuscitation (C-CPR) time before the initiation of ECLS was 77 minutes (IQR, 61-103 minutes) and duration of ECLS was 7 days (IQR, 3-12 days). There were 36 in-hospital deaths (70.6%), and another patient survived after heart transplantation. In the multivariate analysis, single-ventricular physiology (odds ratio [OR], 5.05; p=0.048), open sternum status (OR, 8.69; p=0.013), and C-CPR time (OR, 1.47 per 10 minutes; p=0.021) were significant predictors of in-hospital mortality. In a receiver operating characteristic curve, the optimal cut-off of C-CPR time was 70.5 minutes. The subgroup with early E-CPR (C-CPR time <70.5 minutes) showed a tendency for lower in-hospital mortality tendency (54.5% vs. 82.8%, p=0.060), albeit not statistically significant. Conclusion: If resuscitation fails in an infant, E-CPR could be a life-saving option. It is crucial to improve C-CPR quality and shorten the time before ECLS initiation.

키워드

과제정보

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

참고문헌

  1. Conrad SA, Broman LM, Taccone FS, et al. The extracorporeal life support organization maastricht treaty for nomenclature in extracorporeal life support: a position paper of the extracorporeal life support organization. Am J Respir Crit Care Med 2018;198:447-51. https://doi.org/10.1164/rccm.201710-2130CP
  2. Mattox KL, Beall AC Jr. Resuscitation of the moribund patient using portable cardiopulmonary bypass. Ann Thorac Surg 1976;22:436-42. https://doi.org/10.1016/s0003-4975(10)64452-9
  3. del Nido PJ, Dalton HJ, Thompson AE, Siewers RD. Extracorporeal membrane oxygenator rescue in children during cardiac arrest after cardiac surgery. Circulation 1992;86(5 Suppl):II300-4.
  4. Kleinman ME, Chameides L, Schexnayder SM, et al. Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):S876-908. https://doi.org/10.1161/CIRCULATIONAHA.110.971101
  5. Garcia Guerra G, Zorzela L, Robertson CM, et al. Survival and neurocognitive outcomes in pediatric extracorporeal-cardiopulmonary resuscitation. Resuscitation 2015;96:208-13. https://doi.org/10.1016/j.resuscitation.2015.07.034
  6. Ortmann L, Prodhan P, Gossett J, et al. Outcomes after in-hospital cardiac arrest in children with cardiac disease: a report from Get With the Guidelines: Resuscitation. Circulation 2011;124:2329-37. https://doi.org/10.1161/CIRCULATIONAHA.110.013466
  7. Lasa JJ, Rogers RS, Localio R, et al. Extracorporeal cardiopulmonary resuscitation (E-CPR) during pediatric in-hospital cardiopulmonary arrest is associated with improved survival to discharge: a report from the American Heart Association's Get With The Guidelines-Resuscitation (GWTG-R) Registry. Circulation 2016;133:165-76. https://doi.org/10.1161/CIRCULATIONAHA.115.016082
  8. Meert KL, Guerguerian AM, Barbaro R, et al. Extracorporeal cardiopulmonary resuscitation: one-year survival and neurobehavioral outcome among infants and children with in-hospital cardiac arrest. Crit Care Med 2019;47:393-402. https://doi.org/10.1097/CCM.0000000000003545
  9. Torres-Andres F, Fink EL, Bell MJ, Sharma MS, Yablonsky EJ, Sanchez-de-Toledo J. Survival and long-term functional outcomes for children with cardiac arrest treated with extracorporeal cardiopulmonary resuscitation. Pediatr Crit Care Med 2018;19:451-8. https://doi.org/10.1097/PCC.0000000000001524
  10. Matos RI, Watson RS, Nadkarni VM, et al. Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests. Circulation 2013;127:442-51. https://doi.org/10.1161/CIRCULATIONAHA.112.125625
  11. Kim DH, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Extracorporeal cardiopulmonary resuscitation: predictors of survival. Korean J Thorac Cardiovasc Surg 2016;49:273-9. https://doi.org/10.5090/kjtcs.2016.49.4.273
  12. Chan T, Thiagarajan RR, Frank D, Bratton SL. Survival after extracorporeal cardiopulmonary resuscitation in infants and children with heart disease. J Thorac Cardiovasc Surg 2008;136:984-92. https://doi.org/10.1016/j.jtcvs.2008.03.007
  13. Erek E, Aydin S, Suzan D, et al. Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in children after cardiac surgery. Anatol J Cardiol 2017;17:328-33. https://doi.org/10.14744/AnatolJCardiol.2016.6658
  14. Philip J, Burgman C, Bavare A, et al. Nature of the underlying heart disease affects survival in pediatric patients undergoing extracorporeal cardiopulmonary resuscitation. J Thorac Cardiovasc Surg 2014;148:2367-72. https://doi.org/10.1016/j.jtcvs.2014.03.023
  15. Kane DA, Thiagarajan RR, Wypij D, et al. Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation 2010;122(11 Suppl):S241-8. https://doi.org/10.1161/CIRCULATIONAHA.109.928390
  16. Soar J, Maconochie I, Wyckoff MH, et al. 2019 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2019;145:95-150. https://doi.org/10.1016/j.resuscitation.2019.10.016
  17. Soar J, Maconochie I, Wyckoff MH, et al. 2019 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces. Circulation 2019;140:e826-80. https://doi.org/10.1161/CIR.0000000000000734
  18. Alsoufi B, Awan A, Manlhiot C, et al. Results of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery. Eur J Cardiothorac Surg 2014;45:268-75. https://doi.org/10.1093/ejcts/ezt319
  19. Tsukahara K, Toida C, Muguruma T. Current experience and limitations of extracorporeal cardiopulmonary resuscitation for cardiac arrest in children: a single-center retrospective study. J Intensive Care 2014;2:68. https://doi.org/10.1186/s40560-014-0068-x
  20. Sivarajan VB, Best D, Brizard CP, Shekerdemian LS, d'Udekem Y, Butt W. Duration of resuscitation prior to rescue extracorporeal membrane oxygenation impacts outcome in children with heart disease. Intensive Care Med 2011;37:853-60. https://doi.org/10.1007/s00134-011-2168-6
  21. Huang SC, Wu ET, Chen YS, et al. Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients. Crit Care Med 2008;36:1607-13. https://doi.org/10.1097/CCM.0b013e318170b82b
  22. Delmo Walter EM, Alexi-Meskishvili V, Huebler M, et al. Rescue extracorporeal membrane oxygenation in children with refractory cardiac arrest. Interact Cardiovasc Thorac Surg 2011;12:929-34. https://doi.org/10.1510/icvts.2010.254193
  23. Wolf MJ, Kanter KR, Kirshbom PM, Kogon BE, Wagoner SF. Extracorporeal cardiopulmonary resuscitation for pediatric cardiac patients. Ann Thorac Surg 2012;94:874-80. https://doi.org/10.1016/j.athoracsur.2012.04.040
  24. Kelly RB, Harrison RE. Outcome predictors of pediatric extracorporeal cardiopulmonary resuscitation. Pediatr Cardiol 2010;31:626-33. https://doi.org/10.1007/s00246-010-9659-z
  25. Prodhan P, Fiser RT, Dyamenahalli U, et al. Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unit. Resuscitation 2009;80:1124-9. https://doi.org/10.1016/j.resuscitation.2009.07.004
  26. Morris MC, Wernovsky G, Nadkarni VM. Survival outcomes after extracorporeal cardiopulmonary resuscitation instituted during active chest compressions following refractory in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 2004;5:440-6. https://doi.org/10.1097/01.pcc.0000137356.58150.2e
  27. De Mul A, Nguyen DA, Doell C, Perez MH, Cannizzaro V, Karam O. Prognostic evaluation of mortality after pediatric resuscitation assisted by extracorporeal life support. J Pediatr Intensive Care 2019;8:57-63. https://doi.org/10.1055/s-0038-1667012
  28. McMullan DM, Thiagarajan RR, Smith KM, Rycus PT, Brogan TV. Extracorporeal cardiopulmonary resuscitation outcomes in term and premature neonates*. Pediatr Crit Care Med 2014;15:e9-16. https://doi.org/10.1097/PCC.0b013e3182a553f3