Abstract 18729: Comparative Analysis of the Use of Extracorporeal Membrane Oxygenation During Cardiopulmonary Resuscitation Within a Pediatric Cardiac Intensive Care Unit

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Stephanie J Conrad ◽  
Matthew K Bacon ◽  
Brittney C Hatch ◽  
John David Hughes ◽  
Michelle K Terrell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Mechanical Support ◽  
Cardiac Intensive Care Unit ◽  
Icu Discharge ◽  
Cardiac Intensive Care

Background: Mechanical support to aid in restoration of circulation during cardiopulmonary resuscitation (CPR) is increasingly common in the pediatric cardiac intensive care unit (CICU). We sought to both identify and quantify factors predicting the implementation of extracorporeal membrane oxygenation to support CPR (eCPR). Methods and Results: Events associated with CPR from July 2010 through December 2013 within our pediatric CICU were retrospectively reviewed. Of 135 arrests among 88 patients, 84% were among postsurgical patients and 98% (n=133) resulted in a return of circulation, either spontaneous (n=100, 74%) or with the assistance of mechanical support (n=33, 24%). Median age at arrest was 106 days (interquartile range [IQR] 26-207 days) and weight was 3.9 kg (IQR 3.0-6.0 kg). Median length of stay (LOS) at the time of arrest was 5 days (IQR 1-49 days). Common primary causes included low cardiac output (38%), respiratory failure (33%), and arrhythmia (15%). Univariate predictors of an eCPR arrest included smaller size (3.3 v. 4.3 kg, p=0.004), younger age (25 v. 130 days, p<0.001), shorter length of stay at time of arrest (1 v. 8.5 days, p=0.001), single ventricle physiology (30% v. 14% among biventricular physiology arrests, p=0.04), and arrests not related to respiratory failure (34% v. 5% eCPR among respiratory failure arrests, p<0.001). Unit factors not associated with an increased frequency of arrests resulting in eCPR included unit capacity, night shift, and the experience levels of both the bedside nurse and attending. Among patients with at least one arrest, median ICU LOS was 18 days (IQR 9-72 days) and overall survival to ICU discharge was 72%. Survival to ICU discharge was not significantly different with respect to use of eCPR as compared to conventional CPR (60% v. 77% respectively, p=0.11). Conclusions: We report predictors of the need for mechanical support during cardiopulmonary resuscitation within a pediatric CICU, and demonstrate comparable post-resuscitation survival to ICU discharge among those rescued with eCPR. Further longitudinal investigation is necessary to identify potential eCPR-associated differences in morbidity and neurocognitive outcomes following a CICU arrest.

Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease

2007 ◽  
Vol 17 (S4) ◽  
pp. 116-126 ◽  
Author(s):  
Stacie B. Peddy ◽  
Mary Fran Hazinski ◽  
Peter C. Laussen ◽  
Ravi R. Thiagarajan ◽  
George M. Hoffman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Intensive Care Units ◽  
Cardiac Disease ◽  
Paediatric Intensive Care ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
Paediatric Intensive Care Units

AbstractPulseless cardiac arrest, defined as the cessation of cardiac mechanical activity, determined by unresponsiveness, apneoa, and the absence of a palpable central pulse, accounts for around one-twentieth of admissions to paediatric intensive care units, be they medical or exclusively cardiac. Such cardiac arrest is higher in children admitted to a cardiac as opposed to a paediatric intensive care unit, but the outcome of these patients is better, with just over two-fifths surviving when treated in the cardiac intensive care unit, versus between one-sixth and one-quarter of those admitted to paediatric intensive care units. Children who receive chest compressions for bradycardia with pulses have a significantly higher rate of survival to discharge, at 60%, than do those presenting with pulseless cardiac arrest, with only 27% surviving to discharge. This suggests that early resuscitation before the patient becomes pulseless, along with early recognition and intervention, are likely to improve outcomes. Recently published reports of in-hospital cardiac arrests in children can be derived from the multi-centric National Registry of Cardiopulmonary Resuscitation provided by the American Heart Association. The population is heterogeneous, but most arrests occurred in children with progressive respiratory insufficiency, and/or progressive circulatory shock. During the past 4 years at the Children’s Hospital of Philadelphia, 3.1% of the average 1000 annual admissions to the cardiac intensive care unit have received cardiopulmonary resuscitation. Overall survival of those receiving cardiopulmonary resuscitation was 46%. Survival was better for those receiving cardiopulmonary resuscitation after cardiac surgery, at 53%, compared with survival of 33% for pre-operative or non-surgical patients undergoing resuscitation. Clearly there is room for improvement in outcomes from cardiac resuscitation in children with cardiac disease. In this review, therefore, we summarize the newest developments in paediatric resuscitation, with an expanded focus upon the unique challenges and importance of anticipatory care in infants and children with cardiac disease.

Trends in Therapy and Outcomes Associated With Respiratory Failure in Patients Admitted to the Cardiac Intensive Care Unit

2021 ◽  
pp. 088506662110034
Author(s):  
Jacob C. Jentzer ◽  
Carlos L. Alviar ◽  
P. Elliott Miller ◽  
Thomas Metkus ◽  
Courtney E. Bennett ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Temporal Trends ◽  
Invasive Ventilation ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
Over Time

Purpose: To describe the epidemiology, outcomes, and temporal trends of respiratory failure in the cardiac intensive care unit (CICU). Materials and Methods: Retrospective cohort analysis of 2,986 unique Mayo Clinic CICU patients from 2007 to 2018 with respiratory failure. Temporal trends were analyzed, along with hospital and 1-year mortality. Multivariable logistic regression was used to determine adjusted hospital mortality trends. Results: The prevalence of respiratory failure in the CICU increased from 15% to 38% during the study period ( P < 0.001 for trend). Among patients with respiratory failure, the utilization of invasive ventilation decreased and noninvasive ventilation modalities increased over time. Hospital mortality and 1-year mortality were 24% and 54%, respectively, with variation according to the type of respiratory support (highest among patients receiving invasive ventilation alone: 35% and 46%, respectively). Hospital mortality was highest among patients with concomitant cardiac arrest and/or shock (52% for patients with both). Hospital mortality decreased in the overall population from 35% to 25% ( P < 0.001 for trend), but was unchanged among patients receiving positive-pressure ventilation. Conclusions: The prevalence of respiratory failure in CICU more than doubled during the last decade. The use of noninvasive respiratory support increased, while overall mortality declined over time. Cardiac arrest and shock accounted for the majority of deaths. Further research is needed to optimize the outcomes of high-risk CICU patients with respiratory failure.

scholarly journals Dying in the dark: sunshine, gender and outcomes in myocardial infarction

1998 ◽  
Vol 91 (7) ◽  
pp. 352-354 ◽  
Author(s):  
Kathleen M Beauchemin ◽  
Peter Hays
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Natural Experiment ◽  
Cardiac Patients ◽  
Psychiatric Unit ◽  
Cardiac Intensive Care Unit ◽  
Significant Difference ◽  
Cardiac Intensive Care

We report a natural experiment that took place in a cardiac intensive care unit (CICU). We had been alerted to the possibility that sunny rooms would be conducive to better outcomes by our findings in the psychiatric unit, and by reports that depressed cardiac patients did less well than those in normal mood. The 628 subjects were patients admitted directly to the CICU with a first attack of myocardial infarction (MI). Outcomes of those treated in sunny rooms and those treated in dull rooms were retrospectively compared for fatal outcomes and for length of stay in the CICU. Patients stayed a shorter time in the sunny rooms, but the significant difference was confined to women (2.3 days in sunny rooms, 3.3 days in dull rooms). Mortality in both sexes was consistently higher in dull rooms (39/335 dull, 21/293 sunny). We conclude that illumination may be relevant to outcome in MI, and that this natural experiment merits replication.

Outcome of cardiopulmonary resuscitation in a pediatric cardiac intensive care unit

2000 ◽  
Vol 28 (9) ◽  
pp. 3296-3300 ◽  
Author(s):  
David A. Parra ◽  
Bala R. Totapally ◽  
Evan Zahn ◽  
Jeffrey Jacobs ◽  
Abdul Aldousany ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

scholarly journals Outcome of Cardiopulmonary Resuscitation in a Pediatric Cardiac Intensive Care Unit † 221

1998 ◽  
Vol 43 ◽  
pp. 40-40
Author(s):  
David Parra ◽  
Bala R Totapally ◽  
Evan Zahn ◽  
Jeffrey Jacobs ◽  
Abdul Aldousany ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care
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