Cardiology in the Young

Part 1: A Holistic Approach to Hypoplastic Left Heart Syndrome

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

Heidi J. Daltona1 c1 and Dawn Tuckera2

a1 Division Chief and Professor of Child Health, Phoenix Children's Hospital and University of Arizona College of Medicine, Phoenix, United States of America

a2 Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States of America

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.

(Online publication December 13 2011)

Correspondence:

c1 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