Pediatric Critical Care Medicine:

May 2014 - Volume 15 - Issue 4_suppl - p 131

doi: 10.1097/01.pcc.0000449301.35682.ad

EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION: SINGLE CENTRE EXPERIENCE

Vora, A.; Angadi, U.; Sambo, A.; Barry, P.; Faulkner, G.; Peek, G.

ABSTRACT

Aims: To describe our experience using ECPR on children with cardiac arrest refractory to conventional CPR; and explore predictors of mortality and survival rates for ECPR.

Methods: We retrospectively reviewed all medical records of paediatric patients who received ECMO after ECPR in our hospital from 2004 to 2011. We analysed: cause of cardiac arrest, CPR to ECMO times, complications and survival to discharge rates.

Results: 31 cases of ECPR were identified. 23 cases were cardiac including 10 patients that were post cardiac surgery (RACHS 6/5 = 7); and the remaining 8 cases were respiratory. Survival to discharge was 55%, with deaths recorded from 9 cardiac (RACHS 6/5 = 3) and 5 non-cardiac cases. Hypotension was the main cause of cardiac arrest (18). The median time from CPR to ECMO was 32 minutes (5–278 mins). The median time for CPR to ECMO was less in cases from 2006–2008 compared to 2009–2011 (50 vs. 32 minutes p=0.189). The only identified predictors of mortality from the study were pre ECMO ph of <6.9 (p=0.007) and neonatal age group (p=0.003). Renal dysfunction and mechanical problems such as cannulation and circuit issues accounted for the commonest complications, 70% and 61% respectively; while early neurological complications were experienced in 22% of cases.

Conclusions: The ECPR experience of the unit reflects a similar or slightly better survival outcome (>50%) than that reported in other units, albeit on a smaller number of patients. The study identified neonatal age group and pre ECMO ph of <6.9 to be poor predictors of mortality.