Extracorporeal membrane oxygenation combined with hypothermia therapy for children patients with refractory cardiac arrest after congenital heart disease surgery: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUO Dandong ,  ZHUANG Jian , ZHU Weizhong , ZHOU Chengbin , WU Lan , CHEN Miaoyun , LI Xiaofeng

Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510100, P.R.China;

Corresponding author：

ZHUANG Jian, Email: zhuangjian5413@tom.com

Keywords：

Heart defects, congenital; cardiac surgical procedures; extracorporeal membrane oxygenation; hypothermia therapy; cardiac arrest

DOI：

10.7507/1007-4848.201608062

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Objective To explore the value of extracorporeal membrane oxygenation(ECMO) combined with hypothermia therapy for children patients with refractory cardiac arrest after congenital heart disease surgery. Methods From January 2013 to June 2016, we conducted a prospective study of 23 children (18 males, 5 females at age of 7±11 months) who underwent ECMO for refractory cardiac arrest after congenital heart disease surgery. All patients were randomly divided into two groups: a standard group (11 patients) and a hypothermia group (12 patients). The patients of the standard group received standard therapy (the core body temperature maintaining at 37.0℃) and the hypothermia group received hypothermia therapy (the core body temperature maintaining at 33.0℃). The hospital discharge rate, the rate of weaning from ECMO and the morbidity were compared between the two groups. Results Eleven of 23 patients (47.8%) were weaned from ECMO successfully and 7 of 23 patients (30.4%) discharged from hospital. The hospital discharge rate between the hypothermia group (n=6, 50.0%) and the standard group (n=1, 9.1%) had no statistical difference (χ²=4.537, P=0.069). The rate of weaning from ECMO of the hypothermia group (n=9, 75.0%) was higher than that of the standard group (n=2, 18.2%, χ²=7.425, P=0.006). The morbidity between the two groups had no statistical difference. Conclusion Extracorporeal cardiopulmonary resuscitation can improve the survival rate of the children who suffered from refractory cardiac arrest after congenital heart disease surgery. There is no evidence that ECMO combined with hyperthermia therapy is better than the only ECMO in improving the discharge rate. But ECMO combined with hypothermia therapy has higher rate of weaning from ECMO than that of the only ECMO.

Citation： LUO Dandong, ZHUANG Jian, ZHU Weizhong, ZHOU Chengbin, WU Lan, CHEN Miaoyun, LI Xiaofeng. Extracorporeal membrane oxygenation combined with hypothermia therapy for children patients with refractory cardiac arrest after congenital heart disease surgery: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(8): 580-584. doi: 10.7507/1007-4848.201608062 Copy

1.	Mazzeffi MA, Sanchez PG, Herr D, et al. Outcomes of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in adult cardiac surgery patients. J Thorac Cardiovasc Surg, 2016, 152(4): 1133-1139.
2.	Sato A, Isoda K ,Gatate Y, et al. Successful management of a patient with refractory ventricular fibrillation(VF) due to acute myocardial infarction(AMI) and lung injury by transition from percutaneous cardiopulmonary support(PCPS) to veno-venous extracorporeal membrane oxygenation (ECMO). Intern Med, 2016, 55(14): 1877-1879.
3.	Tran BG, De La Cruz K, Grant S, et al. Temporary venoarterial extracorporeal membrane oxygenation: ten-year experience at a cardiac transplant center. J Intensive Care Med, 2016.
4.	Sakurai A, Kinoshita K, Komatsu T, et al. Comparison of outcomes between patients treated by therapeutic hypothermia for cardiac arrest due to cardiac or respiratory causes. Ther Hypothermia Temp Manag, 2016, 6(3): 130-134.
5.	Coppler PJ, Marill KA, Okonkwo DO, et al. Concordance of brain and core temperature in comatose patients after cardiac arrest. Ther Hypothermia Temp Manag, 2016, 6(4): 194-197.
6.	Ruivo C, Jesus C, Morais J, et al. Predictors of death among cardiac arrest patients after therapeutic hypothermia: A non-tertiary care center's initial experience. Rev Port Cardiol, 2016, 35(7-8): 423-431.
7.	Lan C, Tsai PR, Chen YS, et al. Prognostic factors for adult patients receiving extracorporeal membrane oxygenation as mechanical circulatory support--a 14-year experience at a medical center. Artif Organs, 2010, 34(2): E59-E64.
8.	Schober A, Sterz F, Laggner AN, et al. Admission of out-of-hospital cardiac arrest victims to a high volume cardiac arrest center is linked to improved outcome. Resuscitation, 2016, 106: 42-48.
9.	Masterson S, Cullinan J, McNally B, et al. Out-of-hospital cardiac arrest attended by ambulance services in Ireland: first 2 years' results from a nationwide registry. Emerg Med J, 2016, 33(11): 776-781.
10.	Tsukahara K, Toida C, Muguruma T. Current experience and limitations of extracorporeal cardiopulmonary resuscitation for cardiac arrest in children: a single-center retrospective study. J Intensive Care, 2014, 2(1): 68.
11.	Shin HJ, Song S, Park HK, et al. Results of extracorporeal cardiopulmonary resuscitation in children. Korean J Thorac Cardiovasc Surg, 2016, 49(3): 151-156.
12.	于坤, 黑飞龙, 李景文, 等. 两种体外膜式氧合支持系统的临床应用研究. 中国胸心血管外科临床杂志, 2011, 18(1): 16-21.
13.	赵晓琪, 谷天祥, 喻磊, 等. 亚低温联合持续肾脏替代治疗对心脏外科术后重症心力衰竭的效果研究. 中国胸心血管外科临床杂志, 2016, 23(2): 205-207.
14.	Schenone AL, Cohen A, Patarroyo G, et al. Therapeutic hypothermia after cardiac arrest: a systematic review/meta-analysis exploring the impact of expanded criteria and targeted temperature. Resuscitation, 2016, 108: 102-110.
15.	Gasparetto N, Tarantini G, Perazzolo MM, et al. Combined treatment of refractory cardiac arrest by extracorporeal membrane oxygenation and therapeutic hypothermia. G Ital Cardiol (Rome), 2013, 14(2): 145-148.
16.	Thooft A, Goubella A, Fagnoul D, et al. Combination of veno-arterial extracorporeal membrane oxygenation and hypothermia for out-of-hospital cardiac arrest due to Taxus intoxication. CJEM, 2014, 16(6): 504-507.
17.	Pinichjindasup A, Homvises B, Muengtaweepongsa S. Therapeutic hypothermia with extracorporeal membrane oxygenation (ECMO) and surface cooling in post-cardiac arrest patients: 4 case reports. J Med Assoc Thai, 2014, 97(Suppl 8): S223-S227.
18.	Stub D, Bernard S, Pellegrino V, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation, 2015, 86: 88-94.
19.	Wildschut ED, de Wildt SN, Mathot RA, et al. Effect of hypothermia and extracorporeal life support on drug disposition in neonates. Semin Fetal Neonatal Med, 2013, 18(1): 23-27.
20.	Zhang XW, Xie JF, Chen JX, et al. The effect of mild induced hypothermia on outcomes of patients after cardiac arrest: a systematic review and meta-analysis of randomised controlled trials. Crit Care, 2015, 19417.
21.	Wang CH, Chen NC, Tsai MS, et al. Therapeutic hypothermia and the risk of hemorrhage: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2015, 94(47): e2152.
22.	Lou S, MacLaren G, Clark J, et al. Safety of therapeutic hypothermia in children on veno-arterial extracorporeal membrane oxygenation after cardiac surgery. Cardiol Young, 2015, 25(7): 1367-1373.
23.	Pilecky D, Szudi G, Kovacs E, et al. The role of therapeutic hypothermia in post-resuscitation care-review of the literature and personal experience. Orv Hetil, 2016, 157(16): 611-617.

1. Mazzeffi MA, Sanchez PG, Herr D, et al. Outcomes of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in adult cardiac surgery patients. J Thorac Cardiovasc Surg, 2016, 152(4): 1133-1139.
2. Sato A, Isoda K ,Gatate Y, et al. Successful management of a patient with refractory ventricular fibrillation(VF) due to acute myocardial infarction(AMI) and lung injury by transition from percutaneous cardiopulmonary support(PCPS) to veno-venous extracorporeal membrane oxygenation (ECMO). Intern Med, 2016, 55(14): 1877-1879.
3. Tran BG, De La Cruz K, Grant S, et al. Temporary venoarterial extracorporeal membrane oxygenation: ten-year experience at a cardiac transplant center. J Intensive Care Med, 2016.
4. Sakurai A, Kinoshita K, Komatsu T, et al. Comparison of outcomes between patients treated by therapeutic hypothermia for cardiac arrest due to cardiac or respiratory causes. Ther Hypothermia Temp Manag, 2016, 6(3): 130-134.
5. Coppler PJ, Marill KA, Okonkwo DO, et al. Concordance of brain and core temperature in comatose patients after cardiac arrest. Ther Hypothermia Temp Manag, 2016, 6(4): 194-197.
6. Ruivo C, Jesus C, Morais J, et al. Predictors of death among cardiac arrest patients after therapeutic hypothermia: A non-tertiary care center's initial experience. Rev Port Cardiol, 2016, 35(7-8): 423-431.
7. Lan C, Tsai PR, Chen YS, et al. Prognostic factors for adult patients receiving extracorporeal membrane oxygenation as mechanical circulatory support--a 14-year experience at a medical center. Artif Organs, 2010, 34(2): E59-E64.
8. Schober A, Sterz F, Laggner AN, et al. Admission of out-of-hospital cardiac arrest victims to a high volume cardiac arrest center is linked to improved outcome. Resuscitation, 2016, 106: 42-48.
9. Masterson S, Cullinan J, McNally B, et al. Out-of-hospital cardiac arrest attended by ambulance services in Ireland: first 2 years' results from a nationwide registry. Emerg Med J, 2016, 33(11): 776-781.
10. Tsukahara K, Toida C, Muguruma T. Current experience and limitations of extracorporeal cardiopulmonary resuscitation for cardiac arrest in children: a single-center retrospective study. J Intensive Care, 2014, 2(1): 68.
11. Shin HJ, Song S, Park HK, et al. Results of extracorporeal cardiopulmonary resuscitation in children. Korean J Thorac Cardiovasc Surg, 2016, 49(3): 151-156.
12. 于坤, 黑飞龙, 李景文, 等. 两种体外膜式氧合支持系统的临床应用研究. 中国胸心血管外科临床杂志, 2011, 18(1): 16-21.
13. 赵晓琪, 谷天祥, 喻磊, 等. 亚低温联合持续肾脏替代治疗对心脏外科术后重症心力衰竭的效果研究. 中国胸心血管外科临床杂志, 2016, 23(2): 205-207.
14. Schenone AL, Cohen A, Patarroyo G, et al. Therapeutic hypothermia after cardiac arrest: a systematic review/meta-analysis exploring the impact of expanded criteria and targeted temperature. Resuscitation, 2016, 108: 102-110.
15. Gasparetto N, Tarantini G, Perazzolo MM, et al. Combined treatment of refractory cardiac arrest by extracorporeal membrane oxygenation and therapeutic hypothermia. G Ital Cardiol (Rome), 2013, 14(2): 145-148.
16. Thooft A, Goubella A, Fagnoul D, et al. Combination of veno-arterial extracorporeal membrane oxygenation and hypothermia for out-of-hospital cardiac arrest due to Taxus intoxication. CJEM, 2014, 16(6): 504-507.
17. Pinichjindasup A, Homvises B, Muengtaweepongsa S. Therapeutic hypothermia with extracorporeal membrane oxygenation (ECMO) and surface cooling in post-cardiac arrest patients: 4 case reports. J Med Assoc Thai, 2014, 97(Suppl 8): S223-S227.
18. Stub D, Bernard S, Pellegrino V, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation, 2015, 86: 88-94.
19. Wildschut ED, de Wildt SN, Mathot RA, et al. Effect of hypothermia and extracorporeal life support on drug disposition in neonates. Semin Fetal Neonatal Med, 2013, 18(1): 23-27.
20. Zhang XW, Xie JF, Chen JX, et al. The effect of mild induced hypothermia on outcomes of patients after cardiac arrest: a systematic review and meta-analysis of randomised controlled trials. Crit Care, 2015, 19417.
21. Wang CH, Chen NC, Tsai MS, et al. Therapeutic hypothermia and the risk of hemorrhage: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2015, 94(47): e2152.
22. Lou S, MacLaren G, Clark J, et al. Safety of therapeutic hypothermia in children on veno-arterial extracorporeal membrane oxygenation after cardiac surgery. Cardiol Young, 2015, 25(7): 1367-1373.
23. Pilecky D, Szudi G, Kovacs E, et al. The role of therapeutic hypothermia in post-resuscitation care-review of the literature and personal experience. Orv Hetil, 2016, 157(16): 611-617.

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Extracorporeal membrane oxygenation combined with hypothermia therapy for children patients with refractory cardiac arrest after congenital heart disease surgery: A randomized controlled trial

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