Hostname: page-component-7bb8b95d7b-w7rtg Total loading time: 0 Render date: 2024-09-08T10:19:24.819Z Has data issue: false hasContentIssue false
  • English
  • Français

Resuscitation and Extracorporeal Life Support during Cardiopulmonary Resuscitation following the Norwood (Stage 1) operation

Published online by Cambridge University Press:  13 December 2011

Heidi J. Dalton  and
Dawn Tucker
Heidi J. Dalton*
Affiliation:
Division Chief and Professor of Child Health, Phoenix Children's Hospital and University of Arizona College of Medicine, Phoenix, United States of America
Dawn Tucker
Affiliation:
Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States of America
*
Correspondence to: Dr H. J. Dalton, MD, FCCM, Division Chief and Professor of Child Health, Phoenix Children's Hospital and University of Arizona College of Medicine,, Phoenix, Arizona, United States of America. Tel: +1 602 546 1784; Fax: +1 602 546 1785; E-mail: hdalton@phoenixchildrens.com
Get access Rights & Permissions [Opens in a new window]

Abstract

The success of extracorporeal support in providing cardiopulmonary support for a variety of patients has led to use of Extracorporeal Life Support, also known as ECLS, as a rescue for patients failing conventional resuscitation. The use of Extracorporeal Life Support in circumstances of cardiac arrest has come to be termed “Extracorporeal Life Support during Cardiopulmonary Resuscitation” or “ECPR”. Although Extracorporeal Life Support during Cardiopulmonary Resuscitation was originally described in patients following repair of congenital cardiac defects who suffered a sudden arrest, it has now been used in a variety of circumstances for patients both with and without primary cardiac disease. Multiple centres have reported successful use of Extracorporeal Life Support during Cardiopulmonary Resuscitation in adults and children. However, because of the cost, the complexity of the technique, and the resources required, Extracorporeal Life Support during Cardiopulmonary Resuscitation is not offered in all centres for paediatric patients with refractory cardiac arrest. The increasing success and availability of Extracorporeal Life Support during Cardiopulmonary Resuscitation in post-operative cardiac patients, coupled with the fact that patients undergoing the Norwood (Stage 1) operation can have rapid, unpredictable cardiac deterioration and arrest, has led to a steady increase in the use of Extracorporeal Life Support during Cardiopulmonary Resuscitation in this population. For Extracorporeal Life Support during Cardiopulmonary Resuscitation to be most successful, it must be deployed rapidly while the patient is undergoing excellent cardiopulmonary resuscitation. Early activation of the team that will perform cannulation could possibly shorten the duration of cardiopulmonary resuscitation and might improve survival and outcome. More research needs to be done to refine the populations and circumstances that offer the best outcome with Extracorporeal Life Support during Cardiopulmonary Resuscitation, to evaluate the ratios of cost to benefit, and establish the long-term neurodevelopmental outcomes in survivors.

Keywords

Extracorporeal membrane oxygenationpaediatricscongenital cardiac defecthypoplastic left heart syndromeNorwood
Type
Original Article
Information
Cardiology in the Young , Volume 21 , Issue S2: A Holistic Approach to Hypoplastic Left Heart Syndrome and other evolving challenges in Pediatric and Congenital Cardiac Disease , 13 December 2011 , pp. 101 - 108
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Dalton, HJ, Siewers, RD, Fuhrman, BP, et al. Extracorporeal membrane oxygenation for cardiac rescue in children with severe myocardial dysfunction. Crit Care Med 1993; 21: 1020–1028.CrossRefGoogle ScholarPubMed
2.Fiser, RT, Morris, MC. Extracorporeal cardiopulmonary resuscitation in refractory pediatric cardiac arrest. Pediatr Clin N Am 2008; 55: 929–941.CrossRefGoogle ScholarPubMed
3.del Nido, PJ, Dalton, HJ, Thompson, AE, Siewers, RD. Extracorporeal membrane oxygenator rescue in children during cardiac arrest after cardiac surgery. Circulation 1992; 86 (5 Suppl): II300–II304.Google ScholarPubMed
4.Raymond, TT, Cunnyngham, CB, Thompson, MT, Thomas, JA, Dalton, HJ, Nadkarni, VM, for the American Heart Association National Registry of CPR Investigators. Outcomes among neonates, infants, and children after extracorporeal cardiopulmonary resuscitation for refractory in-hospital pediatric cardiac arrest: a report from the National Registry of CardioPulmonary Resuscitation. Pediatr Crit Care Med 2010; 11: 362–371.Google ScholarPubMed
5.Morris, MC, Wernovsky, G, Nadkarni, VM. Survival outcomes after extracorporeal cardiopulmonary resuscitation instituted during active chest compressions following refractory in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 2004; 5: 440–446.CrossRefGoogle ScholarPubMed
6.Thiagarajan, RR, Laussen, PC, Rycus, PT, Bartlett, RH, Bratton, SL. Extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in infants and children. Circulation 2007; 116: 1693–1700.CrossRefGoogle ScholarPubMed
7.Kleinman, ME, de Caen, AR, Chameides, L, et al. . Pediatric Basic and Advanced Life Support Chapter Collaborators. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Circulation 2010; 122: S466–S515.Google ScholarPubMed
8.Underleider, RM, Shen, I, Yeh, T, et al. Routine mechanical ventricular assist following the Norwood procedure-improved neurologic outcome and excellent hospital survival. Ann Thorac Surg 2004; 77: 18–22.CrossRefGoogle Scholar
9.Hoskote, A, Bohn, D, Gruenwald, C, et al. Extracorporeal life support after staged palliation of a functional single ventricle: subsequent morbidity and survival. J Thorac Cardiovasc Surg 2006; 131: 1114–1121.CrossRefGoogle ScholarPubMed
10.Phelps, H, Mahle, W, Kim, D, et al. Postoperative cerebral oxygenation in hypoplastic left heart syndrome after the Norwood procedure. Ann Thorac Surg 2009; 87: 1490–1494.CrossRefGoogle ScholarPubMed
11.Kumar, S, Zurakowski, D, Dalton, H, et al. Extracorporeal membrane oxygenation in postcardiotomy patients: factors influencing outcome. J Thorac Cardiovasc Surg 2010; 140: 330–336.CrossRefGoogle ScholarPubMed
12.Tweddell, JS, Ghanayem, NS, Mussatto, KA, et al. Mixed venous oxygen saturation monitoring after stage 1 palliation for hypoplastic left heart syndrome. Ann Thorac Surg 2007; 84: 1301–1310.CrossRefGoogle ScholarPubMed
13.Hannan, RL, Ybarra, MA, White, JA, Ojito, JW, Rossi, AF, Burke, RP. Patterns of lactate values after congenital heart surgery and timing of cardiopulmonary support. Ann Thorac Surg 2005; 80: 1468–1474.CrossRefGoogle ScholarPubMed
14.Polimenakos, A, Wojtyla, P, Smith, P, et al. Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle: analysis of outcomes. Eur J Cardiothorac Surg 2011 (Epub ahead of print).CrossRefGoogle ScholarPubMed
15.Lequier, L, Joffe, AR, Robertson, CM, et al. . Western Canadian Complex Pediatric Therapies Program Follow-up Group. Two-year survival, mental, and motor outcomes after cardiac extracorporeal life support at less than five years of age. J Thorac Cardiovasc Surg 2008; 136: 976–983. e3. Epub 2 June 2008.CrossRefGoogle ScholarPubMed
16.Grist, G, Whittaker, C, Merrigan, K, et al. Identifying neonatal and pediatric cardiac congenital diaphragmatic hernia extracorporeal membrane oxygenation patients at increased mortality risk. J Extra Corpor Technol 2010; 42: 183–190.CrossRefGoogle ScholarPubMed
17.Allan, CK, Thiagarajan, RR, del Nido, PJ, Roth, SJ, Almodovar, MC, Laussen, PC. Indication for initiation of mechanical circulatory support impacts survival of infants with shunted single-ventricle circulation supported with extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 2007; 133: 660–667.CrossRefGoogle ScholarPubMed
18.Jaggers, JJ, Forbess, JM, Shah, AS, et al. Extracorporeal membrane oxygenation for infant post-cardiotomy support: significance of shunt management. Ann Thorac Surg 2000; 69: 1476–1483.CrossRefGoogle Scholar
19.Darling, EM, Kaemmer, D, Lawson, D, Jaggers, JJ, Underleider, RM. Use of ECMO without the oxygenator to provide ventricular support after Norwood Stage I procedures. Ann Thorac Surg 2001; 71: 735–736.CrossRefGoogle ScholarPubMed
20.McMullan, DM, Emmert, JA, Permut, LC, et al. Minimizing bleeding associated with mechanical circulatory support following pediatric heart surgery. Eur J Cardiothorac Surg 2011; 39: 392–397.CrossRefGoogle ScholarPubMed
21.Nelson, DP, Andropoulos, DB, Fraser, CD Jr. Review. Perioperative neuroprotective strategies. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2008: 49–56.CrossRefGoogle ScholarPubMed
22.Knirsch, W, Stutz, K, Kretschmar, O, et al. . Working Group on Non-Invasive Haemodynamic Monitoring in Paediatrics. Regional cerebral oxygenation by NIRS does not correlate with central or jugular venous oxygen saturation during interventional catheterisation in children. Acta Anaesthesiol Scand 2008; 52: 1370–1374.CrossRefGoogle ScholarPubMed
23.Prodhan, P, Fiser, RT, Dyamenahalli, U, et al. Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unit. Resuscitation 2009; 80: 1124–1129.CrossRefGoogle ScholarPubMed
24.Alsoufi, B, Al-Radi, OO, Gruenwald, C, et al. Extracorporeal life support following cardiac surgery in children: analysis in a single institution. Eur J Cardiothorac Surg 2009; 35: 1004–1011.CrossRefGoogle ScholarPubMed
25.Huang, SC, Wu, ET, Chen, YS, et al. Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients. Crit Care Med 2008; 36: 1607–1613.CrossRefGoogle ScholarPubMed
26.Chen, YC, Tsai, FC, Chang, CH, et al. Prognosis of patients on extracorporeal membrane oxygenation: the impact of acute kidney injury on mortality. Ann Thorac Surg 2011; 91: 137–142.CrossRefGoogle ScholarPubMed
27.Grist, G, Whittaker, C, Merrigan, K, Fenton, J, Pallotto, E, Lofland, G. Defining the late implementation of extracorporeal membrane oxygenation (ECMO) by identifying increased mortality risk using specific physiologic cut-points in neonatal and pediatric respiratory patients. J Extra Corpor Technol 2009; 41: 213–219.CrossRefGoogle ScholarPubMed
28.Mahle, WT, Forbess, JM, Kirshbom, PM, Cuadrado, AR, Simsic, JM, Kanter, KR. Cost-utility analysis of salvage cardiac extracorporeal membrane oxygenation in children. J Thorac Cardiovasc Surg 2005; 129: 1084–1090.CrossRefGoogle ScholarPubMed
29.Sivarajan, VB, Best, D, Brizard, CP, Shekerdemian, LS, d'Udekem, Y, Butt, W. Duration of resuscitation prior to rescue extracorporeal membrane oxygenation impacts outcome in children with heart disease. Intens Care Med 2011; 37: 853–860; Epub 3 March 2011.CrossRefGoogle ScholarPubMed