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Stratton M, Edmunds K. Extracorporeal Cardiopulmonary Resuscitation: CME Review. Pediatr Emerg Care 2024; 40:618-620. [PMID: 39083660 DOI: 10.1097/pec.0000000000003178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
ABSTRACT Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly being used for refractory cardiac arrest for both in-hospital and out-of-hospital cardiac arrests. The term eCPR refers to cannulating a patient to an extracorporeal membrane oxygenation (ECMO) circuit to provide perfusion after cardiac arrest refractory to standard cardiopulmonary resuscitation. Extracorporeal cardiopulmonary resuscitation has been shown to offer increased survival benefit among a select group of adult and pediatric patients experiencing refractory cardiac arrests, both in hospital and out of hospital. Extracorporeal cardiopulmonary resuscitation should be considered when (1) the cardiac arrest is witnessed, (2) the patient receives high-quality cardiopulmonary resuscitation, (3) the patient is at or in close proximity to an ECMO center, (4) there is a reversible cause for the cardiac arrest where the perfusion from the ECMO circuit serves as a bridge to recovery, and (5) the treating facility has a robust multidisciplinary system in place to facilitate rapidly moving patients from site of arrest to site of cannulation to intensive care unit. To develop an eCPR system of care, a multidisciplinary team consisting of prehospital, emergency medicine, in-hospital, proceduralist, perfusionist, and intensive care medical professionals must be established who support the use of eCPR for refractory cardiac arrest. The future of eCPR is the development of systems of care that use eCPR for a narrow subset of pediatric out-of-hospital cardiac arrests.
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Dantes G, Davis C, Van Anderlecht K, Davis J, Lima L, Linden AF, Paden M, Keene S. Extracorporeal life support use in patients with bronchopulmonary dysplasia: A single center case series. Perfusion 2024:2676591241264437. [PMID: 39046725 DOI: 10.1177/02676591241264437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
PURPOSE Preterm pediatric patients with bronchopulmonary dysplasia (BPD) represent a subgroup previously deemed high risk candidates for ECLS (extracorporeal life support) due to suspected high mortality or increased post ECLS morbidity. The aim of this study was to determine outcomes for patients with an established history of BPD who subsequently required ECLS. METHODS A single center retrospective review was performed between 01/2010-06/2022 for patients less than 2 years of age, born prematurely (<32 weeks) with a subsequent diagnosis of BPD, and who required ECLS for respiratory failure. Demographic and clinical data, including ECLS data, were collected. Speech, language, feeding/swallowing, cognitive, hearing, vision, or motor function deficits were obtained with a median follow up of 42 months following discharge. RESULTS Nineteen patients met criteria. The median birth weight and gestational age was 0.86 kg (IQR 0.73, 1.0) and 26 weeks (IQR 25, 27), respectively. The median chronological age at cannulation was 12.1 months. The most common etiologies for respiratory failure requiring ECLS were viral (68.4%) and bacterial (21.1%) pneumonia. Survival to decannulation was 78.9% (15/19) and survival to hospital discharge was 63.2% (12/19). Amongst survivors to discharge, 42% (5/12) required new or additional home oxygen and 50% (6/12) were noted to have neurodevelopmental/behavioral concerns on follow up at 1 year with 25% (3/12) with concerns beyond a year. CONCLUSION Patients with underlying BPD who require ECLS have comparable mortality and long-term neurodevelopmental outcomes to non-BPD patients with respiratory failure. This information can be useful when considering ECLS candidacy and providing family counseling.
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Affiliation(s)
- Goeto Dantes
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Carolyn Davis
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Joel Davis
- Division of Pediatrics, Department of Critical Care, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lisa Lima
- Division of Pediatrics, Department of Critical Care, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Allison F Linden
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew Paden
- Division of Pediatrics, Department of Critical Care, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sarah Keene
- Department of Neonatology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Loaec M, Himebauch AS, Reeder R, Alvey JS, Race JA, Su L, Lasa JJ, Slovis JC, Raymond TT, Coleman R, Barney BJ, Kilbaugh TJ, Topjian AA, Sutton RM, Morgan RW. Outcomes of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest Among Children With Noncardiac Illness Categories. Crit Care Med 2024; 52:551-562. [PMID: 38156912 DOI: 10.1097/ccm.0000000000006153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVES The objective of this study was to determine the association of the use of extracorporeal cardiopulmonary resuscitation (ECPR) with survival to hospital discharge in pediatric patients with a noncardiac illness category. A secondary objective was to report on trends in ECPR usage in this population for 20 years. DESIGN Retrospective multicenter cohort study. SETTING Hospitals contributing data to the American Heart Association's Get With The Guidelines-Resuscitation registry between 2000 and 2021. PATIENTS Children (<18 yr) with noncardiac illness category who received greater than or equal to 30 minutes of cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Propensity score weighting balanced ECPR and conventional CPR (CCPR) groups on hospital and patient characteristics. Multivariable logistic regression incorporating these scores tested the association of ECPR with survival to discharge. A Bayesian logistic regression model estimated the probability of a positive effect from ECPR. A secondary analysis explored temporal trends in ECPR utilization. Of 875 patients, 159 received ECPR and 716 received CCPR. The median age was 1.0 [interquartile range: 0.2-7.0] year. Most patients (597/875; 68%) had a primary diagnosis of respiratory insufficiency. Median CPR duration was 45 [35-63] minutes. ECPR use increased over time ( p < 0.001). We did not identify differences in survival to discharge between the ECPR group (21.4%) and the CCPR group (16.2%) in univariable analysis ( p = 0.13) or propensity-weighted multivariable logistic regression (adjusted odds ratio 1.42 [95% CI, 0.84-2.40; p = 0.19]). The Bayesian model estimated an 85.1% posterior probability of a positive effect of ECPR on survival to discharge. CONCLUSIONS ECPR usage increased substantially for the last 20 years. We failed to identify a significant association between ECPR and survival to hospital discharge, although a post hoc Bayesian analysis suggested a survival benefit (85% posterior probability).
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Affiliation(s)
- Morgann Loaec
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
- Resuscitation Science Center, CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Adam S Himebauch
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
- Resuscitation Science Center, CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ron Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Jessica S Alvey
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Jonathan A Race
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Lillian Su
- Division of Cardiac Intensive Care, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - Javier J Lasa
- Division of Cardiology and Critical Care, Department of Pediatrics, UT Southwestern Medical Center, Dallas TX
| | - Julia C Slovis
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
- Resuscitation Science Center, CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Tia T Raymond
- Department of Pediatrics, Cardiac Critical Care Medicine, Medical City Children's Hospital, Dallas TX
| | - Ryan Coleman
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston TX
| | - Bradley J Barney
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Todd J Kilbaugh
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
- Resuscitation Science Center, CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alexis A Topjian
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
- Resuscitation Science Center, CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Robert M Sutton
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
- Resuscitation Science Center, CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ryan W Morgan
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
- Resuscitation Science Center, CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
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Akinpelu T, Shah NR, Weaver K, Muller N, McElroy J, Bhalala US. Implications of pediatric extracorporeal cardiopulmonary resuscitation simulation for intensive care team confidence and coordination: A pilot study. Perfusion 2023:2676591231202679. [PMID: 37702710 DOI: 10.1177/02676591231202679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Extracorporeal cardiopulmonary resuscitation (ECPR) is associated with improved outcomes in select populations, however, crisis resource management (CRM) in this setting is logistically challenging. This study evaluates the impact of ECPR simulation on self-perceived confidence and collaboration of intensive care unit team members. METHODS This is a prospective observational study analyzing data obtained between July 2018-December 2019. This study focused on non-surgical members of critical care team consisting of pediatric intensivists, resident physicians, registered nurses, respiratory therapists. Participants were expected to perform cardiopulmonary resuscitation (CPR) during the ECPR event, participate in code-team responsibilities and provide ancillary support during cannulation. Pre- and post-simulation surveys employed the Likert scale (1 = not at all confident, 5 = highly confident) to assess self-perceived scores in specified clinical competencies. RESULTS Twenty-nine providers participated in the simulation; 38% had prior ECPR experience. Compared to mean pre-study Likert scores (2.4, 2.4, 2.5), post-simulation scores increased (4.2, 4.4, 4.3) when self-evaluating: confidence in assessing patients needing ECPR, confidence in participating in ECPR workflow and confidence in performing high-quality CPR, respectively. Post-simulation values of >3 were reported by 100% of participants in all domains (p < .0001). All participants indicated the clinical scenario and procedural environment to be realistic and appropriately reflective of situational stress. Additionally, 100% of participants reported the simulation to improve perceived team communication and teamwork skills. CONCLUSION This study demonstrated preliminary feasibility of pediatric ECPR simulation in enhancing independent provider confidence and team communication. This self-perceived improvement may establish a foundation for cohesive CRM, in preparation for a real life ECPR encounter.
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Affiliation(s)
- Toluwani Akinpelu
- Department of Anesthesiology and Critical Care Medicine, Driscoll Children's Hospital, Corpus Christi, TX, USA
- University of Texas - Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | - Nikhil R Shah
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Karen Weaver
- Department of Pediatrics, The Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Nicole Muller
- Department of Pediatrics, The Children's Hospital of San Antonio, San Antonio, TX, USA
| | - James McElroy
- Department of Pediatrics, The Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Utpal S Bhalala
- Department of Anesthesiology and Critical Care Medicine, Driscoll Children's Hospital, Corpus Christi, TX, USA
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
- Department of Critical Care, Texas A&M University, College Station, TX, USA
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