J Extra Corpor Technol 2023 , 55 , 197 – 200 Ó The Author ( s ), published by EDP Sciences , 2023 https :// doi . org / 10.1051 / ject / 2023019
Available online at : ject . edpsciences . org
CASE REPORT
ECPR for prolonged Pediatric Cardiac Arrest , an outcome without major neurological compromise Laura Gutiérrez-Soriano ( MD ) 1 , Eduardo Becerra Zapata ( MD ) 2 ,* , Nicolas Maya Trujillo ( MD ) 2 , German Andres Franco Gruntorad ( MD ) 2 , and Pedro Hurtado Peña ( MD ) 3
1 Cardiovascular Anesthesiologist Anesthesiology Department , Fundación Cardioinfantil , 1113111 Bogota , Colombia 2 Anesthesiology Department , Fundación Cardioinfantil , 1113111 Bogota , Colombia 3 Anesthesiology Department , Hospital Universitario San Ignacio , 1113111 Bogota , Colombia
Received 27 January 2023 , Accepted 24 May 2023
Abstract – Pediatric in-hospital cardiac arrest ( IHCA ) has been reported in 1 – 3 % of pediatric intensive care unit ( ICU ) admissions and up to 6 % of children admissions to the cardiac ICU . In the last 25 years , the survival to hospital discharge after pediatric IHCA has improved from 9 % to 13.7 % up to 35 %. The improvement in outcomes was attributed in part to the application of ECMO as a rescue strategy when prolonged conventional CPR cannot restore spontaneous circulation . We report a case of a 4-month-old patient with a history of ventricular and septal defects , with left to right shunt and enlargement of left heart chambers that underwent surgery for the closure of the atrial and septal defects , and experienced complications that led to the use of ECMO in response to a prolonged cardiac arrest .
Key words : Pediatrics extracorporeal membrane oxygenation , Cardiac arrest , Extracorporeal cardiopulmonary resuscitation , Ischemic preconditioning , Congenital heart disease , Postoperative care .
Introduction
This report describes the surgical procedure of a 4-monthold boy with ventricular septum and atrial septal defects who underwent a medium sternotomy . The surgical closure of the ventricular septal defect and primary surgical closure of the atrial septal defect were performed without complications . However , the patient experienced oxygen desaturation , bradycardia , and asystole in the early perioperative period while respiratory therapy was performed , leading to a cardiac arrest . Emergent sternotomy and open heart massage were performed , and the patient was put on VA ECMO ( Venoarterial Extracorporeal Membrane Oxygenation ) support after 1 h of cardiac arrest . Despite the initial suboptimal flow given by the patient ’ shemodynamic instability with VA ECMO support , the patient eventually recovered and underwent decannulation and repair of the residual ventricular septal defect under cardiopulmonary bypass . The patient had a successful recovery but showed mild abnormally low muscle tone at discharge . This case report highlights the successful management of a pediatric patient who experienced a cardiac arrest during the perioperative period with the use of venoarterial ECMO support .
Abbreviations
E-CPR ECMO CNN CPR ICU IHCA IPP Pre Sx VA ECMO
Case presentation
Extracorporeal Cardiopulmonary Resuscitation Once in ECMO During Cannulation Cardiopulmonary Resuscitation Intensive Care Unit In-Hospital Cardiac Arrest Immediate Postoperative Period Pre Surgical VenoArterial Extracorporeal Membrane Oxygenation
Here we discuss a 4-month-old male patient , with a history of ventricular septum defect of 11 mm and atrial septal defect of 5 mm with left to right shunt and a mild enlargement of the left ventricle and atria , without pulmonary hypertension and normal biventricular function . The patient underwent surgery through a medium sternotomy . After aortic and bicaval cannulation , an aortic cross-clamp was performed , antegrade del Nido cardioplegia was achieved with 80 mL of plasmalyte solution
* Corresponding author : eduardo . becerra @ urosario . edu . co
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