Pediatric extracorporeal cardiopulmonary resuscitation: single-center study

Authors: TANIL KENDİRLİ, SERHAN ÖZCAN, MERVE HAVAN, ÇAĞDAŞ BARAN, MEHMET ÇAKICI, BURCU ARICI, ÖZLEM SELVİ CAN, ZEYNEP EYİLETEN, TAYFUN UÇAR, HASAN ERCAN TUTAR, AHMET RÜÇHAN AKAR

Abstract: Background/aim: Extracorporeal cardiopulmonary resuscitation (ECPR) is defined as the venoarterial extracorporeal membrane oxygenation (VA-ECMO) support in a patient who experienced a sudden pulseless condition attributable to cessation of cardiac mechanical activity and circulation. We aimed to evaluate the clinical outcomes of our ECPR experience in a pediatric patient population. Materials and methods: Between September 2014 and November 2017, 15 children were supported with ECPR following in-hospital cardiac arrest (IHCA) in our hospitals. VA-ECMO setting was established for all patients. Pediatric cerebral performance category (PCPC) scales and long-term neurological prognosis of the survivors were assessed. Results: The median age of the study population was 60 (4-156) months. The median weight was 18 (4.8-145) kg, height was 115 (63-172) cm, and body surface area was 0.73 (0.27-2.49) m2 . The cause of cardiac arrest was a cardiac and circulatory failure in 12 patients (80%) and noncardiac causes in 20%. Dysrhythmia was present in 46%, septic shock in 13%, bleeding in 6%, low cardiac output syndrome in 13%, and airway disease in 6% of the study population. Median low-flow time was 95 (range 20-320) min. Central VAECMO cannulation was placed in only 2 (13.3%) cases. However, the return of spontaneous circulation (ROSC) was obtained in 10 (66.6%) patients, and 5 (50%) of them survived. Overall, 5 patients were discharged from the hospital. Finally, survival following ECPR was 33.3%, and all survivors were neurologically intact at hospital-discharge. Conclusion: ECPR can be a life-saving therapeutic strategy using a promising technology in the pediatric IHCA population. Early initiation and a well-coordinated, skilled, and dedicated ECMO team are the mainstay for better survival rates.

Keywords: Extracorporeal cardiopulmonary resuscitation, extracorporeal membrane oxygenation, children

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