Extracorporeal cardiopulmonary resuscitation in adults and children: A review of literature, published guidelines and pediatric single-center program building experience

Olson, Taylor; Anders, Marc; Burgman, Cole; Stephens, A. W.; Bastero, Patricia

doi:10.3389/fmed.2022.935424

Cited by 6 publications

(4 citation statements)

References 212 publications

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“…Multiple studies in adults have demonstrated improved survival with ECPR compared to conventional CPR, considering survival to discharge and neurological impairment outcomes [3]. These findings have also been demonstrated in a recent systemic review and meta-analysis that reported 30% survival with favorable neurological outcomes [8]. These results seem to indicate that ECPR may play a favorable role in improving pediatric cardiac arrest outcomes.…”

Section: Discussionmentioning

confidence: 75%

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The Role of Extracorporeal Cardiopulmonary Resuscitation in Pediatric Intraoperative Cardiac Arrest

Salgueirinho,

Correia,

Graça

et al. 2024

Cureus

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Refractory pediatric intraoperative cardiac arrest is a rare but challenging situation for the anesthesiologist. This case describes an intraoperative extracorporeal cardiopulmonary resuscitation (ECPR) in a 16-year-old male who suffered a sudden cardiac arrest during elective thoracolumbar stabilization. The patient recovered to his pre-operative baseline without any neurological sequela secondary to cardiac arrest. Good quality of conventional resuscitation measures, prompt activation of the extracorporeal membrane oxygenation (ECMO) team, and a multidisciplinary coordinated approach were key factors in ECPR success. Despite the lack of robust evidence in pediatrics, case reports like ours outline the life-saving potential of intraoperative ECPR in refractory cardiac arrest scenarios.

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Section: Discussionmentioning

confidence: 75%

“…This efficient approach was mainly due to the clinical field where the cardiac arrest occurs -the operative room. In this specific scenario, continuous monitoring allows prompt detection and immediate assistance reducing the no-flow time [8].…”

Section: Conclusion Additional Information Author Contributionsmentioning

confidence: 99%

The Role of Extracorporeal Cardiopulmonary Resuscitation in Pediatric Intraoperative Cardiac Arrest

Salgueirinho,

Correia,

Graça

et al. 2024

Cureus

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“…54 In the future, carefully selected randomised-controlled trials are necessary to aid in patient selection, pre-ECPR practice, and post-ECPR practice. 97 The use of artificial intelligence to predict cardiac arrest in children has been studied and seems promising. 98,99 Further research and development is needed to deploy these algorithms in daily practice.…”

Section: Future Directionsmentioning

confidence: 99%

The approach to extracorporeal cardiopulmonary resuscitation (ECPR) in children. A narrative review by the paediatric ECPR working group of EuroELSO

Mensink,

Desai,

Cvetkovic

et al. 2024

Perfusion

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Extracorporeal Cardiopulmonary Resuscitation (ECPR) has potential benefits compared to conventional Cardiopulmonary Resuscitation (CCPR) in children. Although no randomised trials for paediatric ECPR have been conducted, there is extensive literature on survival, neurological outcome and risk factors for survival. Based on current literature and guidelines, we suggest recommendations for deployment of paediatric ECPR emphasising the requirement for protocols, training, and timely intervention to enhance patient outcomes. Factors related to outcomes of paediatric ECPR include initial underlying rhythm, CCPR duration, quality of CCPR, medications during CCPR, cannulation site, acidosis and renal dysfunction. Based on current evidence and experience, we provide an approach to patient selection, ECMO initiation and management in ECPR regarding blood and sweep flow settings, unloading of the left ventricle, diagnostics whilst on ECMO, temperature targets, neuromonitoring as well as suggested weaning and decannulation strategies.

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“…Despite advances in resuscitation science and ECMO technology, there remain questions about how to deliver extracorporeal CPR (ECPR) to optimize survival and neurologic outcomes (2–7). The use of ECPR has become increasingly common as outcomes improve in comparison to conventional CPR and variability in its delivery is emerging (5, 8–11).…”

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confidence: 99%

Epinephrine Dosing Use During Extracorporeal Cardiopulmonary Resuscitation: Single-Center Retrospective Cohort*

Kucher

Márquez

Guerguerian

et al. 2023

Pediatric Critical Care Medicine

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Objectives: During pediatric cardiac arrest, contemporary guidelines recommend dosing epinephrine at regular intervals, including in patients requiring extracorporeal membrane oxygenation (ECMO). The impact of epinephrine-induced vasoconstriction on systemic afterload and venoarterial ECMO support is not well-defined. Design: Nested retrospective observational study within a single center. The primary exposure was time from last dose of epinephrine to initiation of ECMO flow; secondary exposures included cumulative epinephrine dose and arrest time. Systemic afterload was assessed by mean arterial pressure and use of systemic vasodilator therapy; ECMO pump flow and Vasoactive-Inotrope Score (VIS) were used as measures of ECMO support. Clearance of lactate was followed post-cannulation as a marker of systemic perfusion. Setting: PICU and cardiac ICU in a quaternary-care center. Patients: Patients 0–18 years old who required ECMO cannulation during resuscitation over the 6 years, 2014–2020. Patients were excluded if ECMO was initiated before cardiac arrest or if the resuscitation record was incomplete. Interventions: None. Measurements and Main Results: A total of 92 events in 87 patients, with 69 events having complete data for analysis. The median (interquartile range) of total epinephrine dosing was 65 mcg/kg (37–101 mcg/kg), with the last dose given 6 minutes (2–16 min) before the initiation of ECMO flows. Shorter interval between last epinephrine dose and ECMO initiation was associated with increased use of vasodilators within 6 hours of ECMO (p = 0.05), but not with mean arterial pressure after 1 hour of support (estimate, –0.34; p = 0.06). No other associations were identified between epinephrine delivery and mean arterial blood pressure, vasodilator use, pump speed, VIS, or lactate clearance. Conclusions: There is limited evidence to support the idea that regular dosing of epinephrine during cardiac arrest is associated with increased in afterload after ECMO cannulation. Additional studies are needed to validate findings against ECMO flows and clinically relevant outcomes.

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Extracorporeal cardiopulmonary resuscitation in adults and children: A review of literature, published guidelines and pediatric single-center program building experience

Cited by 6 publications

References 212 publications

The Role of Extracorporeal Cardiopulmonary Resuscitation in Pediatric Intraoperative Cardiac Arrest

The Role of Extracorporeal Cardiopulmonary Resuscitation in Pediatric Intraoperative Cardiac Arrest

The approach to extracorporeal cardiopulmonary resuscitation (ECPR) in children. A narrative review by the paediatric ECPR working group of EuroELSO

Epinephrine Dosing Use During Extracorporeal Cardiopulmonary Resuscitation: Single-Center Retrospective Cohort*

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