Extracorporeal Cardiopulmonary Resuscitation for Pediatric Cardiac Patients

Wolf, Michael; Kanter, Kirk R.; Kirshbom, Paul M.; Kogon, Brian; Wagoner, Scott

doi:10.1016/j.athoracsur.2012.04.040

Cited by 106 publications

(70 citation statements)

References 12 publications

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“…However, survival for ECPR in HLHS patients is generally lower than the 40-55% ECPR survival reported for cardiac patients with a broad range of diagnosis and including postoperative and nonoperative patients (7,9,14,15). The decreased survival outcomes for ECMO in HLHS neonates following S1P may reflect patient and ECMO management challenges specific to this population.…”

Section: Discussionmentioning

confidence: 51%

“…Thus, generalizing these findings to children with HLHS undergoing S1P may be difficult. Current single-center reports of survival following ECPR in HLHS patients following S1P report variable survival outcomes (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Because cardiac arrest and use of ECPR in neonates with HLHS undergoing S1P is commonplace and maintaining an ECPR program is expensive, improving our understanding of potential benefits, namely survival to discharge, morbidity, and long-term outcomes in this population, is critical.…”

mentioning

confidence: 96%

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Extracorporeal Membrane Oxygenation–Supported Cardiopulmonary Resuscitation Following Stage 1 Palliation for Hypoplastic Left Heart Syndrome*

Jolley

Yarlagadda

Rajagopal

et al. 2014

Pediatric Critical Care Medicine

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Section: Discussionmentioning

confidence: 51%

mentioning

confidence: 96%

Extracorporeal Membrane Oxygenation–Supported Cardiopulmonary Resuscitation Following Stage 1 Palliation for Hypoplastic Left Heart Syndrome*

Jolley

Yarlagadda

Rajagopal

et al. 2014

Pediatric Critical Care Medicine

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“…However, duration of CPR was identified as is a strong predictor of survival in a recent large, singlecenter study (15 min survivors vs. 40 min non-survivors, P=0.009), in which children who required ≥30 min of CPR had 79% reduced odds of hospital survival (24). Several single-center published reports do not identify duration of CPR as a predictor of ECPR survival but the difference in median duration of CPR between survivors and nonsurvivors was generally small (<5 min) (25)(26)(27). In contrast, pre-ECLS resuscitation >30 minutes has been identified as a significant independent risk factor of mortality in adults who experience out-of-hospital cardiac arrest (28).…”

Section: Duration Of Pre-ecpr Resuscitationmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation

Yam

McMullan

2017

Ann. Transl. Med.

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Extracorporeal life support (ECLS) is used for patients in isolated or combined cardiopulmonary failures. The use of ECLS to rescue patients with cardiac arrest that is refractory to conventional cardiopulmonary resuscitation has been shown to improve survival in many patient populations. Increasing recognition of the survival benefit associated with extracorporeal cardiopulmonary resuscitation (ECPR) has led to increased use of ECPR during the past decade. This review provides an overview of ECPR utilization; population-based clinical outcomes, resource utilization and costs associated this advanced form of life support therapy.

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“…Morris et al 32 Paden et al 2 Polimenakos et al 26 Prodhan et al 27 Raymond et al 8 Shah et al 33 Sivarajan et al 34 Thiagarajan et al 6 Tajik and Cardarelli 7 Wolf et al 24 Thourani et al 25 630 (40) 8 (57) 24 (72) 87 (44) 9 (33) 14 (38) 261 (38) 114 ( survive after treatment with ECPR. 8 Few published data support preexisting measurements as indicators for survival.…”

Section: Referencementioning

confidence: 99%

“…However, survival statistics for ECPR are more encouraging, with a general rate of success of near 40% to 60%. [2][3][4][5][7][8][9][10][11][12][13][19][20][21][22][23][24][25][26] Multi-institutional data obtained in 2012 from the Extracorporeal Life Support Organization (ELSO), an international registry and database of ECMO treatment, demonstrated that ECPR was successful for 934 out of 2236 neonatal and pediatric patients, with survival to discharge of 39% for neonates and 40% for children. Other retrospective, single-institution studies have shown survival rates as high as 72% to 80%.…”

Section: The Benefits Of Ecprmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest

Ryan

2015

Critical Care Nurse

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It is only fitting that the first neonate to be supported by extracorporeal membrane oxygenation (ECMO) was named Esperanza, which when translated from Spanish means hope.1 Indeed, to the more than 50 000 patients who have survived because of ECMO, this revolutionary treatment has provided hope where there was none before. 2 In the past 5 decades, the use of artificial oxygenation and perfusion has revolutionized the care of critically ill patients, both in the operating room and in the intensive care unit. Use of artificial oxygenation and perfusion has evolved from bypass during cardiac surgery to advanced life support, to complex extracorporeal cardiopulmonary resuscitation (ECPR). Within the past 20 years, ECPR has been initiated when traditional resuscitation methods have failed and has proven its effectiveness with a survival to discharge rate of approximately 40%.3-13 However, the appropriate use of this therapy and delineated criteria for initiating and withdrawing this therapy have yet to be defined. Furthermore, implementation of this Pediatric CareExtracorporeal cardiopulmonary resuscitation (ECPR) remains a promising treatment for pediatric patients in cardiac arrest unresponsive to traditional cardiopulmonary resuscitation. With veno-arterial extracorporeal support, blood is drained from the right atrium, oxygenated through the extracorporeal circuit, and transfused back to the body, bypassing the heart and lungs. The use of artificial oxygenation and perfusion thus provides the body a period of hemodynamic stability, while allowing resolution of underlying disease processes. Survival rates for ECPR patients are higher than those for traditional cardiopulmonary resuscitation (CPR), although neurological outcomes require further investigation. The impact of duration of CPR and length of treatment with extracorporeal membrane oxygenation vary in published reports. Furthermore, current guidelines for the initiation and use of ECPR are limited and may lead to confusion about appropriate use of this support. Many ethical concerns arise with this advanced form of life support. More often than not, the dilemma is not whether to withhold ECPR, but rather when to withdraw it. Although clinicians must decide if ECPR is appropriate and when further intervention is futile, the ultimate burden of choice is left to the patient's caregivers. Offering support and guidance to the patient's family as well as the patient is essential. (Critical Care Nurse. 2015;35[1]:60-70) This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Determine the difference between venovenous and venoarterial extracorporeal membrane oxygenation (ECMO) 2. Describe the benefits of extracorporeal cardiopulmonary resuscitation 3. Discuss the ethical considerations related to management of patients undergoing ECMO CNE Continuing Nursing Education

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Extracorporeal Cardiopulmonary Resuscitation for Pediatric Cardiac Patients

Cited by 106 publications

References 12 publications

Extracorporeal Membrane Oxygenation–Supported Cardiopulmonary Resuscitation Following Stage 1 Palliation for Hypoplastic Left Heart Syndrome*

Extracorporeal Membrane Oxygenation–Supported Cardiopulmonary Resuscitation Following Stage 1 Palliation for Hypoplastic Left Heart Syndrome*

Extracorporeal cardiopulmonary resuscitation

Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest

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