Cardiology in the Young

Part 1: A Holistic Approach to Hypoplastic Left Heart Syndrome

Extracorporeal cardiopulmonary resuscitation for post-operative cardiac arrest: indications, techniques, controversies, and early results – what is known (and unknown)

Paul J. Chaia1 c1, Jeffrey P. Jacobsa1, Heidi J. Daltona2, John M. Costelloa3, David S. Coopera1, Roxanne Kirscha4, Tami Rosenthala4, Joseph N. Grazianoa2 and James A. Quintessenzaa1

a1 The Congenital Heart Institute of Florida, All Children's Hospital, Saint Petersburg, Florida, United States of America

a2 Division Chief and Professor of Child Health, Phoenix Children's Hospital and University of Arizona College of Medicine, Phoenix, United States of America

a3 Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America

a4 Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America

Abstract

Extracorporeal cardiopulmonary resuscitation may be defined as the use of extracorporeal membrane oxygenation for the support of patients who do not respond to conventional cardiopulmonary resuscitation. Data from national and international paediatric databases indicate that the use of extracorporeal cardiopulmonary resuscitation is increasing. Guidelines from the American Heart Association suggest that any patient with refractory cardiopulmonary resuscitation and potentially reversible causes of cardiac arrest is a candidate for extracorporeal cardiopulmonary resuscitation. One possible framework for selection of patients for extracorporeal cardiopulmonary resuscitation includes dividing patients on the basis of favourable or unfavourable characteristics. Favourable characteristics include cardiac disease, witnessed event in the intensive care unit, ability to deliver effective cardiopulmonary resuscitation, active patient monitoring present, favourable arterial blood gases, and early institution of extracorporeal membrane oxygenation. Unfavourable characteristics potentially include non-cardiac disease, an unwitnessed cardiac arrest, ineffective cardiopulmonary resuscitation, and severely acidotic arterial blood gases. Considering the significant resources and cost involved in the use of extracorporeal cardiopulmonary resuscitation, its use needs to be critically examined to improve outcomes, assess neurological recovery and quality of life, and help identify populations and other factors that may help guide in the selection of patients for successful extracorporeal cardiopulmonary resuscitation.

(Online publication December 13 2011)

Correspondence:

c1 Correspondence to: Dr P. J. Chai, MD, Pediatric Cardiac Surgery, The Congenital Heart Institute of Florida, 625 6th Avenue South, Suite 475, Saint Petersburg, Florida 33701, United States of America. Tel: (727) 822-6666; Fax: (727) 821-5994; E-mail: pjchai@gmail.com

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