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J Thorac Cardiovasc Surg 2008;136:984-992
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Survival after extracorporeal cardiopulmonary resuscitation in infants and children with heart disease

^a Division of Pediatric Critical Care, Department of Pediatrics, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah
^b Division of Cardiology, Children's Hospital Boston, and the Department of Pediatrics Harvard Medical School, Boston, Mass

Received for publication November 8, 2007; revisions received February 6, 2008; accepted for publication March 2, 2008.

^_* Address for reprints: Titus Chan, MD, Department of Pediatrics, Division of Critical Care Medicine, University of Utah, PO Box 581289, Salt Lake City, UT 84158-1289. (Email: tituschan{at}gmail.com).

Objective: We investigated survival and predictors of mortality for infants and children with heart disease treated with extracorporeal membrane oxygenation as an aid to cardiopulmonary resuscitation.

Methods: Children (<18 years) with heart disease who received extracorporeal cardiopulmonary resuscitation and were reported to the Extracorporeal Life Support Organization database were evaluated. Patients were classified into one of 3 groups based on underlying cardiac physiology: single ventricle, 2 ventricles, and cardiac muscle disease. Patients with eligible procedure codes were assigned a Risk Adjustment for Congenital Heart Surgery-1 classification.

Results: Four hundred ninety-two patients were eligible for analysis, and 279 (57%) were assigned a Risk Adjustment for Congenital Heart Surgery-1 category. Overall survival was 42%. In a multivariable logistic regression analysis, significant pre-extracorporeal predictors for mortality included single-ventricle physiology (odds ratio, 1.6; 95% confidence interval, 1.05–2.4), a history of a stage 1–type procedure (odds ratio, 2.7; 95% confidence interval, 1.2–6.2), and extreme acidosis (arterial blood gas pH < 7.01; odds ratio, 2.2; 95% confidence interval, 1.3–3.7). Right carotid artery cannulation was associated with decreased mortality risk (odds ratio, 0.6; 95% confidence interval, 0.4–0.9). During extracorporeal support, complications, including renal injury, evidence of neurologic injury, and persistent acidosis, were associated with an increased risk of hospital mortality.

Conclusion: Use of extracorporeal membrane oxygenation as an adjunct to cardiopulmonary resuscitation resulted in hospital survival in 42% of infants and children with heart disease. Underlying cardiac physiology and associated cardiac surgical procedures influenced mortality, as did pre-extracorporeal resuscitation status and extracorporeal membrane oxygenation–associated complications.