Results of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery

Bahaaldin Alsoufi, Abid Awan, Cedric Manlhiot, Alexandr Guechef, Zohair Al-Halees, Mamdouh Al-Ahmadi, Brian W. McCrindle, Avedis Kalloghlian

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Survival of children having cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest following surgical correction of congenital heart disease. METHODS: Demographic, anatomical, clinical, surgical and support details of children requiring postoperative ECPR (2007-12) were included in multivariable logistic regression models to determine the factors associated with survival. RESULTS: Thirty-nine children, median age 44 days (4 days-10 years), required postoperative ECPR at a median interval of 1 day (up to 15 days) after surgery. Thirteen (33%) children had single-ventricle pathology; Risk Adjustment in Congenital Heart Surgery (RACHS)-1 categories were 2, 3, 4 and 6 in 6, 15, 13 and 5 patients, respectively. Median CPR duration was 34 (8-125) min, while median support duration was 4 (1-17) days. Seven (18%) patients underwent cardiac re-operation, 28 (72%) survived >24 h after support discontinuation and 16 (41%) survived. Survival rates in neonates, infants and older children were 53, 39 and 17% (P = 0.13). Survival rates for single- vs two-ventricle pathology patients were 54 and 35%, (P = 0.25) and 50, 47, 23 and 60% in RACHS-1 2, 3, 4 and 6 patients, respectively (P = 0.37). Survivors had shorter CPR duration (25 vs 34 min, P = 0.05), lower pre-arrest lactate (2.6 vs 4.6 mmol/l, P = 0.05) and postextracorporeal membrane oxygenation (ECMO) peak lactate (15.4 vs 20.0 mmol/l, P < 0.001). On multivariable analysis, factors associated with death were higher immediate post-ECMO lactate (odds ratio, OR 1.34 per mmol/l, P = 0.008) and renal failure requiring haemodialysis (OR 14.1, P = 0.01). CONCLUSIONS: ECPR plays a valuable role in children having refractory postoperative cardiac arrest. Survival is unrelated to cardiac physiology or surgical complexity. Timely support prior to the emergence of end-organ injury and surgical correction of residual cardiac lesions might enhance survival.

Original languageEnglish (US)
Article numberezt319
Pages (from-to)268-275
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume45
Issue number2
DOIs
StatePublished - Feb 1 2014
Externally publishedYes

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Cardiopulmonary Resuscitation
Heart Arrest
Thoracic Surgery
Risk Adjustment
Lactic Acid
Survival
Survival Rate
Logistic Models
Pathology
Intraoperative Complications
Ambulatory Surgical Procedures
Renal Insufficiency
Survivors
Renal Dialysis
Heart Diseases
Odds Ratio
Demography
Newborn Infant
Membranes

Keywords

  • Cardiac arrest
  • Congenital heart disease
  • Extracorporeal life support
  • Single ventricle

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Results of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery. / Alsoufi, Bahaaldin; Awan, Abid; Manlhiot, Cedric; Guechef, Alexandr; Al-Halees, Zohair; Al-Ahmadi, Mamdouh; McCrindle, Brian W.; Kalloghlian, Avedis.

In: European Journal of Cardio-thoracic Surgery, Vol. 45, No. 2, ezt319, 01.02.2014, p. 268-275.

Research output: Contribution to journalArticle

Alsoufi, Bahaaldin ; Awan, Abid ; Manlhiot, Cedric ; Guechef, Alexandr ; Al-Halees, Zohair ; Al-Ahmadi, Mamdouh ; McCrindle, Brian W. ; Kalloghlian, Avedis. / Results of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery. In: European Journal of Cardio-thoracic Surgery. 2014 ; Vol. 45, No. 2. pp. 268-275.
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abstract = "OBJECTIVES: Survival of children having cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest following surgical correction of congenital heart disease. METHODS: Demographic, anatomical, clinical, surgical and support details of children requiring postoperative ECPR (2007-12) were included in multivariable logistic regression models to determine the factors associated with survival. RESULTS: Thirty-nine children, median age 44 days (4 days-10 years), required postoperative ECPR at a median interval of 1 day (up to 15 days) after surgery. Thirteen (33{\%}) children had single-ventricle pathology; Risk Adjustment in Congenital Heart Surgery (RACHS)-1 categories were 2, 3, 4 and 6 in 6, 15, 13 and 5 patients, respectively. Median CPR duration was 34 (8-125) min, while median support duration was 4 (1-17) days. Seven (18{\%}) patients underwent cardiac re-operation, 28 (72{\%}) survived >24 h after support discontinuation and 16 (41{\%}) survived. Survival rates in neonates, infants and older children were 53, 39 and 17{\%} (P = 0.13). Survival rates for single- vs two-ventricle pathology patients were 54 and 35{\%}, (P = 0.25) and 50, 47, 23 and 60{\%} in RACHS-1 2, 3, 4 and 6 patients, respectively (P = 0.37). Survivors had shorter CPR duration (25 vs 34 min, P = 0.05), lower pre-arrest lactate (2.6 vs 4.6 mmol/l, P = 0.05) and postextracorporeal membrane oxygenation (ECMO) peak lactate (15.4 vs 20.0 mmol/l, P < 0.001). On multivariable analysis, factors associated with death were higher immediate post-ECMO lactate (odds ratio, OR 1.34 per mmol/l, P = 0.008) and renal failure requiring haemodialysis (OR 14.1, P = 0.01). CONCLUSIONS: ECPR plays a valuable role in children having refractory postoperative cardiac arrest. Survival is unrelated to cardiac physiology or surgical complexity. Timely support prior to the emergence of end-organ injury and surgical correction of residual cardiac lesions might enhance survival.",
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AU - Awan, Abid

AU - Manlhiot, Cedric

AU - Guechef, Alexandr

AU - Al-Halees, Zohair

AU - Al-Ahmadi, Mamdouh

AU - McCrindle, Brian W.

AU - Kalloghlian, Avedis

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N2 - OBJECTIVES: Survival of children having cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest following surgical correction of congenital heart disease. METHODS: Demographic, anatomical, clinical, surgical and support details of children requiring postoperative ECPR (2007-12) were included in multivariable logistic regression models to determine the factors associated with survival. RESULTS: Thirty-nine children, median age 44 days (4 days-10 years), required postoperative ECPR at a median interval of 1 day (up to 15 days) after surgery. Thirteen (33%) children had single-ventricle pathology; Risk Adjustment in Congenital Heart Surgery (RACHS)-1 categories were 2, 3, 4 and 6 in 6, 15, 13 and 5 patients, respectively. Median CPR duration was 34 (8-125) min, while median support duration was 4 (1-17) days. Seven (18%) patients underwent cardiac re-operation, 28 (72%) survived >24 h after support discontinuation and 16 (41%) survived. Survival rates in neonates, infants and older children were 53, 39 and 17% (P = 0.13). Survival rates for single- vs two-ventricle pathology patients were 54 and 35%, (P = 0.25) and 50, 47, 23 and 60% in RACHS-1 2, 3, 4 and 6 patients, respectively (P = 0.37). Survivors had shorter CPR duration (25 vs 34 min, P = 0.05), lower pre-arrest lactate (2.6 vs 4.6 mmol/l, P = 0.05) and postextracorporeal membrane oxygenation (ECMO) peak lactate (15.4 vs 20.0 mmol/l, P < 0.001). On multivariable analysis, factors associated with death were higher immediate post-ECMO lactate (odds ratio, OR 1.34 per mmol/l, P = 0.008) and renal failure requiring haemodialysis (OR 14.1, P = 0.01). CONCLUSIONS: ECPR plays a valuable role in children having refractory postoperative cardiac arrest. Survival is unrelated to cardiac physiology or surgical complexity. Timely support prior to the emergence of end-organ injury and surgical correction of residual cardiac lesions might enhance survival.

AB - OBJECTIVES: Survival of children having cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest following surgical correction of congenital heart disease. METHODS: Demographic, anatomical, clinical, surgical and support details of children requiring postoperative ECPR (2007-12) were included in multivariable logistic regression models to determine the factors associated with survival. RESULTS: Thirty-nine children, median age 44 days (4 days-10 years), required postoperative ECPR at a median interval of 1 day (up to 15 days) after surgery. Thirteen (33%) children had single-ventricle pathology; Risk Adjustment in Congenital Heart Surgery (RACHS)-1 categories were 2, 3, 4 and 6 in 6, 15, 13 and 5 patients, respectively. Median CPR duration was 34 (8-125) min, while median support duration was 4 (1-17) days. Seven (18%) patients underwent cardiac re-operation, 28 (72%) survived >24 h after support discontinuation and 16 (41%) survived. Survival rates in neonates, infants and older children were 53, 39 and 17% (P = 0.13). Survival rates for single- vs two-ventricle pathology patients were 54 and 35%, (P = 0.25) and 50, 47, 23 and 60% in RACHS-1 2, 3, 4 and 6 patients, respectively (P = 0.37). Survivors had shorter CPR duration (25 vs 34 min, P = 0.05), lower pre-arrest lactate (2.6 vs 4.6 mmol/l, P = 0.05) and postextracorporeal membrane oxygenation (ECMO) peak lactate (15.4 vs 20.0 mmol/l, P < 0.001). On multivariable analysis, factors associated with death were higher immediate post-ECMO lactate (odds ratio, OR 1.34 per mmol/l, P = 0.008) and renal failure requiring haemodialysis (OR 14.1, P = 0.01). CONCLUSIONS: ECPR plays a valuable role in children having refractory postoperative cardiac arrest. Survival is unrelated to cardiac physiology or surgical complexity. Timely support prior to the emergence of end-organ injury and surgical correction of residual cardiac lesions might enhance survival.

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