Deshpande Shriprasad R, Vaiyani Danish, Cuadrado Angel R, McKenzie E Dean, Maher Kevin O
Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.
Heart Transplant and Advanced Cardiac Therapies Program, Children's National Heart Institute, Washington, DC, USA.
Int J Artif Organs. 2020 Jan;43(1):62-65. doi: 10.1177/0391398819876940. Epub 2019 Sep 23.
Outcomes of out-of-hospital cardiac arrest are poor irrespective of the patient age group and circumstances. Survival to discharge after out-of-hospital arrest in children is less than 10%. Use of extracorporeal cardiopulmonary resuscitation is increasing and has been shown to improve outcomes in some situations. However, the candidacy for such augmentation is based on patient selection, institutional practices, and availability of an extracorporeal membrane oxygenation center. Often, duration of resuscitation, low flow state, presenting pH, and circumstances of arrest dictate candidacy for extracorporeal membrane oxygenation. We present a case of extremely prolonged resuscitation for out-of-hospital arrest in a pediatric patient, and we describe the use of mechanical compression device and transition to extracorporeal membrane oxygenation. We present the case outcome as well as brief discussion about controversies in extracorporeal cardiopulmonary resuscitation. We hope the case provides an opportunity for further discussion regarding opportunities to improve selection, use of extracorporeal cardiopulmonary resuscitation, and impact outcomes.
院外心脏骤停的预后很差，无论患者年龄组和具体情况如何。儿童院外心脏骤停后出院存活的比例不到10%。体外心肺复苏的使用正在增加，并且已证明在某些情况下可改善预后。然而，这种强化治疗的候选资格是基于患者选择、机构实践以及体外膜肺氧合中心的可及性。通常，复苏持续时间、低流量状态、初始pH值以及心脏骤停情况决定了体外膜肺氧合的候选资格。我们报告一例儿科患者院外心脏骤停后进行极长时间复苏的病例，并描述了机械按压装置的使用以及向体外膜肺氧合的过渡。我们展示了病例结果，并简要讨论了体外心肺复苏中的争议。我们希望该病例能为进一步讨论改善体外心肺复苏的选择、使用及其对预后的影响提供契机。
