Extracorporeal cardiopulmonary resuscitation (EC-CPR) for hypothermic arrest in children: is meaningful survival a reasonable expectation?

PURPOSE

We have previously reported the use of EC-CPR for the treatment of hypothermic cardiac arrest with an overall survival of 50%. As we have continued this protocol for an additional 5 years, we sought to update this information.

METHODS

We reviewed all of the activations for hypothermic cardiac arrest from 2005 to 2011. Results are presented as means with minimum and maximum values. The 95% confidence interval for the point estimate of survival was calculated using a binomial distribution.

RESULTS

Nine children were placed on EC-CPR for hypothermic cardiac arrest. Two patients survived to discharge and were neurologically normal. The other seven patients were adequately supported with veno-arterial EC-CPR but met brain death criteria after rewarming prompting withdrawal of support. Four of these went on to multiple organ donation. The overall survival in the series was 22% with a 95% confidence interval from 4% to 58%.

CONCLUSION

Cold water drowning and avalanche suffocations cause dramatic hypothermic cardiac arrests in previously robust children. A protocolized rapid response with EC-CPR can save some of these children despite prolonged periods of cardiac arrest prior to initiation of bypass. The overall survival rate is likely less than our prior more optimistic report suggested.