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KMID : 1812420230560030162
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Journal of Chest Surgery
2023 Volume.56 No. 3 p.162 ~ p.170
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Extracorporeal Cardiopulmonary Resuscitation in Infants: Outcomes and Predictors of Mortality
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Yoo Byeong-A
Yoo Seung-Mo
Choi Eun-Seok
Kwon Bo-Sang
Park Chun-Soo
Yun Tae-Jin
Kim Dong-Hee
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Abstract
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Background : Extracorporeal cardiopulmonary resuscitation (E-CPR) plays an indispensable role when resuscitation fails; however, extracorporeal life support (ECLS) in infants is different from that in adults. The objective of this study was to evaluate the outcomes of E-CPR in infants.
Methods : A single-center retrospective study was conducted, analyzing 51 consecutive patients (age <1 year) who received E-CPR for in-hospital cardiac arrest between 2010 and 2021.
Result : The median age and body weight was 51 days (interquartile range [IQR], 17?111 days) and 3.4 kg (IQR, 2.9?5.1 kg), respectively. The cause of arrest was cardiogenic in 45 patients (88.2%), and 48 patients (94.1%) had congenital cardiac anomalies. The median conventional cardiopulmonary resuscitation (C-CPR) time before the initiation of ECLS was 77 minutes (IQR, 61?103 minutes) and duration of ECLS was 7 days (IQR, 3?12 days). There were 36 in-hospital deaths (70.6%), and another patient survived after heart transplantation. In the multivariate analysis, single-ventricular physiology (odds ratio [OR], 5.05; p=0.048), open sternum status (OR, 8.69; p=0.013), and C-CPR time (OR, 1.47 per 10 minutes; p=0.021) were significant predictors of in-hospital mortality. In a receiver operating characteristic curve, the optimal cut-off of C-CPR time was 70.5 minutes. The subgroup with early E-CPR (C-CPR time <70.5 minutes) showed a tendency for lower in-hospital mortality tendency (54.5% vs. 82.8%, p=0.060), albeit not statistically significant.
Conclusion : If resuscitation fails in an infant, E-CPR could be a life-saving option. It is crucial to improve C-CPR quality and shorten the time before ECLS initiation.
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KEYWORD
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Pediatric cardiopulmonary resuscitation, Conventional cardiopulmonary resuscitation, Extracorporeal cardiopulmonary resuscitation, Pediatric extracorporeal membrane oxygentation
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