Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle: Analysis of outcomes

Anastasios Charalanpos Polimenakos, Patrice Wojtyla, Pamela J. Smith, Vincent Rizzo, Melissa Nater, Chawki F. El Zein, Michel N. Ilbawi

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objective: Extracorporeal cardiopulmonary resuscitation (ECPR) in children with cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) has been reported with encouraging results. We sought to review outcomes of neonates with functional single ventricle (FSV) receiving post-cardiotomy ECPR. Methods: Forty-eight patients who required post-cardiotomy extracorporeal membrane oxygenation (ECMO) since the introduction of our ECPR protocol (January2007-December 2009) were identified. Twenty-seven were neonates. Review of records and survival analysis were conducted. Results: Of 27 neonates receiving post-cardiotomy ECMO 20 had FSV. Fourteen had ECPR. Ten underwent Norwood operation (NO) for hypoplastic left heart syndrome (HLHS). Four had FSV other than HLHS. Three underwent Damus-Kay-Stansel or modified NO with systemic-to-pulmonary shunt (SPS) and one SPS with anomalous pulmonary venous connection repair. Mean age and weight were 7.8 ± 2.9 days and 3.44 ± 1.78. kg, respectively. ECMO median duration was 6 days (interquartile range (IQR) 3-14). Survival to ECMO discontinuation was 79% (11 of 14 patients) and at hospital discharge was 57% (8 of 14 patients). The most common cause of death was multi-organ failure (four of six deaths). At last follow-up (median: 11 months (1-34)) 43% of patients were alive. CPR mean duration for patients with favorable versus unfavorable outcome was 38.6 ± 6.3 versus 42.1 ± 7.7. min (p= 0.12). Previously reported determinants for poorer prognosis in conventional non-rescue ECMO (such as pre-ECMO pH < 7.2, renal, neurological or pulmonary hemorrhage complications, and pre- and post-vasoactive inotropic score) did not influence outcome between survivors and non-survivors (p> 0.05). Conclusions: ECMO support in neonates with FSV requiring ECPR can result in favorable outcome in more than half of patients at hospital discharge. Aggressive strategy toward timely application of ECPR is justified. Expeditious ECPR deployment after proper patients' selection, refinement of CPR quality and use of adjunctive neuroprotective interventions, such as induced hypothermia, might further improve outcomes.

Original languageEnglish (US)
Pages (from-to)1396-1405
Number of pages10
JournalEuropean Journal of Cardio-thoracic Surgery
Volume40
Issue number6
DOIs
StatePublished - Dec 1 2011

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Cardiopulmonary Resuscitation
Extracorporeal Membrane Oxygenation
Newborn Infant
Norwood Procedures
Hypoplastic Left Heart Syndrome
Lung
Induced Hypothermia
Survival Analysis
Heart Arrest
Patient Selection
Cause of Death
Weights and Measures
Survival

Keywords

  • Extracorporeal cardiopulmonary resuscitation

ASJC Scopus subject areas

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

Cite this

Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle : Analysis of outcomes. / Polimenakos, Anastasios Charalanpos; Wojtyla, Patrice; Smith, Pamela J.; Rizzo, Vincent; Nater, Melissa; El Zein, Chawki F.; Ilbawi, Michel N.

In: European Journal of Cardio-thoracic Surgery, Vol. 40, No. 6, 01.12.2011, p. 1396-1405.

Research output: Contribution to journalArticle

Polimenakos, Anastasios Charalanpos ; Wojtyla, Patrice ; Smith, Pamela J. ; Rizzo, Vincent ; Nater, Melissa ; El Zein, Chawki F. ; Ilbawi, Michel N. / Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle : Analysis of outcomes. In: European Journal of Cardio-thoracic Surgery. 2011 ; Vol. 40, No. 6. pp. 1396-1405.
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T1 - Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle

T2 - Analysis of outcomes

AU - Polimenakos, Anastasios Charalanpos

AU - Wojtyla, Patrice

AU - Smith, Pamela J.

AU - Rizzo, Vincent

AU - Nater, Melissa

AU - El Zein, Chawki F.

AU - Ilbawi, Michel N.

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N2 - Objective: Extracorporeal cardiopulmonary resuscitation (ECPR) in children with cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) has been reported with encouraging results. We sought to review outcomes of neonates with functional single ventricle (FSV) receiving post-cardiotomy ECPR. Methods: Forty-eight patients who required post-cardiotomy extracorporeal membrane oxygenation (ECMO) since the introduction of our ECPR protocol (January2007-December 2009) were identified. Twenty-seven were neonates. Review of records and survival analysis were conducted. Results: Of 27 neonates receiving post-cardiotomy ECMO 20 had FSV. Fourteen had ECPR. Ten underwent Norwood operation (NO) for hypoplastic left heart syndrome (HLHS). Four had FSV other than HLHS. Three underwent Damus-Kay-Stansel or modified NO with systemic-to-pulmonary shunt (SPS) and one SPS with anomalous pulmonary venous connection repair. Mean age and weight were 7.8 ± 2.9 days and 3.44 ± 1.78. kg, respectively. ECMO median duration was 6 days (interquartile range (IQR) 3-14). Survival to ECMO discontinuation was 79% (11 of 14 patients) and at hospital discharge was 57% (8 of 14 patients). The most common cause of death was multi-organ failure (four of six deaths). At last follow-up (median: 11 months (1-34)) 43% of patients were alive. CPR mean duration for patients with favorable versus unfavorable outcome was 38.6 ± 6.3 versus 42.1 ± 7.7. min (p= 0.12). Previously reported determinants for poorer prognosis in conventional non-rescue ECMO (such as pre-ECMO pH < 7.2, renal, neurological or pulmonary hemorrhage complications, and pre- and post-vasoactive inotropic score) did not influence outcome between survivors and non-survivors (p> 0.05). Conclusions: ECMO support in neonates with FSV requiring ECPR can result in favorable outcome in more than half of patients at hospital discharge. Aggressive strategy toward timely application of ECPR is justified. Expeditious ECPR deployment after proper patients' selection, refinement of CPR quality and use of adjunctive neuroprotective interventions, such as induced hypothermia, might further improve outcomes.

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