HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marcelo G. Cardarelli Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tajik, M. Articles by Cardarelli, M. G. Search for Related Content PubMed PubMed Citation Articles by Tajik, M. Articles by Cardarelli, M. G. Related Collections Mechanical Circulatory Assistance

Review

Extracorporeal membrane oxygenation after cardiac arrest in children: what do we know?

^a School of Medicine and Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
^b University of Maryland Medical Center, Division of Cardiac Surgery, Baltimore, Maryland, United States

Received 3 October 2007; received in revised form 13 December 2007; accepted 14 December 2007.

^_* Corresponding author. Tel.: +1 410 328 5842; fax: +1 410 328 2750. (Email: mcard001{at}umaryland.edu).

The use of extracorporeal membrane oxygenation (ECMO) as a resuscitative measure during or after manual cardiopulmonary resuscitation (CPR) shows sharply contrasting results. To assess the added value of ECMO in this situation and looking for predictors of mortality we performed a meta-analysis of individual patients collected from observational studies. An electronic Pubmed search restricted to English language publications between 1990 and 2007 using a consensus restrictive criterion retrieved 462 titles. Of those, 93 abstracts were considered appropriate for full text evaluation with 37 articles being included in our meta-analysis. In addition, unpublished data on a series of 98 non-duplicated patients from the author of one of the included studies was added. Data on 288 individually identified patients with a median age of 0.50 years and a median weight was 4.5 kg and demonstrated an overall survival to hospital discharge of 39.6% (114/288). Neurological complications were common, affecting 27% of all patients (77/288) and 14% of those discharged alive (16/114). Other common complications were renal failure (25%) and sepsis (17%). Odds ratios for mortality were higher for the presence of: any complication (OR 3.9, 95% CL 2.3–6.4), neurological (OR 3.3, 95% CL 1.7–6.1), renal (OR 5.1, 95% CL 2.5–10.3) and when the implementation of ECMO took >30 min (OR 2.1, 95% CL 1.1–3.8). Neck vessels cannulation had a lower association with mortality (p < .001). Simple rate comparison between manual CPR alone and the use of emergency ECMO shows a difference on survival to discharge of 12–23%. Its effectiveness is higher when implemented in the first 30 min after arrest. Age and weight do not seem to influence mortality. The incidence of complications is high, particularly neurological and renal, having a strong influence on survival. The specific characteristics of the neurological complications and their long-term effects on survivors are poorly reported in the literature.

Key Words: ECMO • Children • Pediatric • Cardiac arrest

This article has been cited by other articles:

				D. T. Haile and G. J. Schears Optimal Time for Initiating Extracorporeal Membrane Oxygenation Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2009; 13(3): 146 - 153. [Abstract] [PDF]

				L. K. von Segesser Post-cardiac surgery arrest: what to do in the ICU (intensive care unit) Eur. J. Cardiothorac. Surg., July 1, 2009; 36(1): 1 - 2. [Full Text] [PDF]