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Outcomes of paediatric cardiac patients after 30 minutes of cardiopulmonary resuscitation prior to extracorporeal support

Published online by Cambridge University Press:  31 March 2020

Pilar Anton-Martin Open the ORCID record for Pilar Anton-Martin [Opens in a new window] ,
Axel Moreira ,
Paul Kang  and
Michael L. Green
Pilar Anton-Martin*
Affiliation:
Department of Pediatrics, Division of Cardiology, University of Tennessee Health Science Center/Le Bonheur Children’s Hospital, Memphis, TN, USA
Axel Moreira
Affiliation:
Department of Pediatrics, Division of Critical Care, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX, USA
Paul Kang
Affiliation:
Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Phoenix, AZ, USA
Michael L. Green
Affiliation:
Department of Pediatrics, Division of Critical Care, University of Texas Southwestern Medical Center/Children’s Health Children’s Medical Center, Dallas, TX, USA
*
Author for correspondence: P. Anton-Martin, MD, PhD, Department of Pediatrics, Division of Cardiology, University of Tennessee Health Science Center/Le Bonheur Children’s Hospital, Memphis, Tennessee, USA. Tel: +901 604 2811; Fax: +901 287 5970; E-mail: pilarantonmartin@gmail.com
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Abstract

Objectives:

To characterise the mortality and neurological outcomes of paediatric cardiac patients requiring cardiopulmonary resuscitation for more than 30 minutes prior to extracorporeal membrane oxygenation cannulation and to identify risk factors associated with adverse outcomes in this population.

Materials and methods:

Observational retrospective cohort study in paediatric cardiac patients undergoing cardiopulmonary resuscitation for greater than 30 minutes prior to cannulation in a tertiary children’s hospital, from July 2000 to July 2013.

Results:

Seventy-three paediatric cardiac patients requiring cardiopulmonary resuscitation for more than 30 minutes prior to cannulation were included in the study. Survival to hospital discharge was 43.8%, with 75% of survivors having either normal neurologic function or only mild disability. Multivariable logistic regression analysis demonstrated that increased use of calcium during resuscitation (odds ratio 14.5, p 0.01), cardiopulmonary resuscitation duration >50 minutes (odds ratio 4.12, p 0.03), >6 interruptions of chest compressions during cannulation (odds ratio 6.40, p 0.03), the need for continuous renal replacement therapy (odds ratio 11.1, p 0.001), and abnormal pupillary response during extracorporeal membrane oxygenation (odds ratio 33.9, p 0.006) were independent predictors for hospital mortality.

Conclusion:

Survival after cardiopulmonary resuscitation for more than 30 minutes prior to extracorporeal membrane oxygenation cannulation in our paediatric cardiac cohort was 43.8%. Factors associated with mortality included calcium use during resuscitation, longer cardiopulmonary resuscitation, increased chest compression pauses during cannulation, the use of continuous renal replacement therapy, and abnormal pupils during extracorporeal membrane oxygenation support. A prospective assessment of these factors in paediatric cardiac patients may be beneficial in improving outcomes.

Keywords

Extracorporeal membrane oxygenationextracorporeal cardiopulmonary resuscitationcardiac arrestcardiopulmonary resuscitationsurvivalneurological outcomes
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 5 , May 2020 , pp. 607 - 616
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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