Identifying Prognostic Criteria for Survival after Resuscitation Assisted by Extracorporeal Membrane Oxygenation.

Alexandrine Brunner,Peter C Rimensberger,Natacha Dubois,Oliver Karam

doi:10.1155/2016/9521091

Abstract

To improve survival rates during CPR, some patients are put on extracorporeal membrane oxygenation (ECMO). Among children who have undergone ECMO cardiopulmonary resuscitation (ECPR), the overall rate of survival to discharge is close to 40%. However, despite its wide acceptance and use, the appropriate indications and organizational requirements for ECPR have yet to be defined. Our objective was to assess the clinical outcomes of children after ECPR and to determine pre-ECPR prognostic factors for survival to guide its indication. Among the 19 patients who underwent ECPR between 2008 and 2014 in our center, 16 patients (84%, 95% confidence interval: 62–95%) died during their hospital stay, including nine (47%) who were on ECMO and seven (37%) after successful weaning from ECMO. All three survivors had normal cognitive status, but one child suffered from spastic quadriplegia. Survivors tended to have lower lactate, higher bicarbonate, and higher pH levels before ECMO initiation, as well as shorter length of resuscitation. In conclusion, in our center, ECPR has a poorer outcome than expected. Therefore, it might be important to identify, a priori, patients who might benefit from this treatment.

Highlights

Since the 1980s, extracorporeal membrane oxygenation (ECMO) has been used during cardiopulmonary resuscitation (CPR) to improve outcomes in selected patients, as a bridge to cardiac recovery or transplantation
According to the international registry of the Extracorporeal Life Support Organization (ELSO), more than 2370 children have benefited from ECMO-assisted CPR (ECPR) since its introduction [1]
Our data suggest that higher lactate, lower pH, and lower bicarbonate levels before ECMO cannulation, as well as longer duration of CPR before

Summary

Introduction

Since the 1980s, extracorporeal membrane oxygenation (ECMO) has been used during cardiopulmonary resuscitation (CPR) to improve outcomes in selected patients, as a bridge to cardiac recovery or transplantation. The 1-year survival rate has been reported to be less than 5% for children after CPR lasting more than 30 minutes for out-of-hospital arrests [2]. The rate of survival to hospital discharge after ECPR in children is between 41% [1] and 49% [3].

Objectives

Results

Conclusion