Pediatric in-intensive-care-unit cardiac arrest: Incidence, survival, and predictive factors*

Mos, Nienke de; Litsenburg, Raphaële R. L. van; McCrindle, Brian W.; Bohn, Desmond; Parshuram, Christopher S.

doi:10.1097/01.ccm.0000208440.66756.c2

Cited by 188 publications

(112 citation statements)

References 20 publications

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“…Several pediatric studies have shown increased mortality rates for patients cannulated after 30 minutes of conventional CPR. 7,11,28,34 However, other retrospective studies [8][9][10]12,20,26,27,29,31,32 of pediatric patients have shown positive outcomes with median CPR duration of 30 to 50 minutes. Even more interesting are the multiple case reports 24,27,30,32,37 of successful cannulation and survival to discharge in patients receiving CPR of up to 90 to 220 minutes.…”

Section: Population Of Patientsmentioning

confidence: 96%

“…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%

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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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Section: Population Of Patientsmentioning

confidence: 96%

Section: The Benefits Of Ecprmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest

Ryan

2015

Critical Care Nurse

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“…Although the return of spontaneous circulation is seen in 30 to 65% of pediatric patients following a cardiac arrest (more commonly found in-hospital cardiac arrest) long-term survival with good neurological recovery that may be achieved in only a minority [158][159][160]. Common causes of death in nonsurvivors are brain death or neurological futility, particularly among patients who have an out-of-hospital arrest [161].…”

Section: Advances In Cerebral Resuscitation In Childrenmentioning

confidence: 99%

Pediatric Neurocritical Care

Murphy

2012

Neurotherapeutics

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Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.

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“…For the critical outcome of survival to hospital discharge, we identified very-low-quality evidence from 4 pediatric observational studies of IHCA [71][72][73][74] (downgraded for indirectness, inconsistency, and residual confounding) and very-low-quality evidence from 1 unpublished analysis of a study' s public dataset 75 (downgraded for serious risk of residual confounding) showing no benefit to the use of ECPR when compared with CPR without the use of ECMO (RR range, 0.64-1.63). We also identified low-quality evidence (downgraded for indirectness, inconsistency, and residual confounding) from a single pediatric study of IHCA 76 that showed benefit to ECPR when compared with CPR without the use of ECMO (OR, 2.5; 95% CI, 1.3-4.5; P50.007 in surgical cardiac diagnoses; OR, 3.8; 95% CI, 1.4-5.8; P50.011 in medical cardiac diagnoses).…”

Section: Consensus On Sciencementioning

confidence: 99%