Abstract
BackgroundThere are few reports detailing the importance of extracorporeal membrane oxygenation (ECMO) for pediatric cardiac arrest in Japan. We investigated the status and issues surrounding extracorporeal cardiopulmonary resuscitation (ECPR) at our institution.MethodsPatients aged <15 years who underwent ECPR between April 1, 2003 and March 31, 2012 were eligible. The characteristics, cannulation site, durations of cardiopulmonary resuscitation (CPR), cannulation procedure, and ECMO, and neurologic outcomes were retrospectively reviewed. A favorable neurologic outcome was defined as Pediatric Cerebral Performance Categories 1 and 2.ResultsA total of 21 ECPR events were identified. The median CPR and cannulation durations were 60 and 25 min, respectively. Central and peripheral access sites were employed in 15 and six cases, respectively. Five of the 21 patients (24%) were successfully weaned from ECMO and three of the 21 (14%) survived. Two of the three survivors had a favorable neurologic outcome.ConclusionsThe mortality of patients undergoing ECPR at our institution was low. However, about 10% of all patients had a favorable neurologic outcome, which suggests that ECPR may be effective in pediatric cardiac arrest patients.
Highlights
There are few reports detailing the importance of extracorporeal membrane oxygenation (ECMO) for pediatric cardiac arrest in Japan
A return of spontaneous circulation (ROSC) following in-hospital pediatric cardiac arrests is achieved in 67% of patients; many patients do not survive
It has been reported that the use of extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (CPR) (ECPR) successfully resuscitated patients in cardiac arrest, with a mortality rate after extracorporeal cardiopulmonary resuscitation (ECPR) of 14%–40% in adults [2,3] and 33%–51% in children [1,4-7]
Summary
There are few reports detailing the importance of extracorporeal membrane oxygenation (ECMO) for pediatric cardiac arrest in Japan. We investigated the status and issues surrounding extracorporeal cardiopulmonary resuscitation (ECPR) at our institution. If conventional cardiopulmonary resuscitation (CPR) is prolonged (>30 min), the prognosis is even poorer [1]. It has been reported that the use of extracorporeal membrane oxygenation (ECMO) during CPR (ECPR) successfully resuscitated patients in cardiac arrest, with a mortality rate after ECPR of 14%–40% in adults [2,3] and 33%–51% in children [1,4-7]. In Japan, there are few reports of pediatric cases in only a few facilities. The ECPR technique is more difficult to perform in pediatric patients and requires significant resources and an experienced team. The number of children who have been resuscitated by ECMO is unclear
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