OUTCOME OF INFANTS REQUIRING CARDIOPULMONARY-RESUSCITATION BEFORE EXTRACORPOREAL MEMBRANE-OXYGENATION

Background/Purpose: Cardiopulmonary resuscitation (CPR) is reported to be used in a significant number of neonates before initiation of extr acorporeal membrane oxygenation (ECMO). This report establishes the in cidence of infants who require CPR before initiation of ECMO a nd eluc idates survival rates and long-term neurological outcomes. In addition , the authors sought prognostic factors that could reliably predict su rvival or long-term neurological outcome before initiating ECMO suppor t. Methods: The Extracorporeal Life Support Organization (ELSO) regist ry provided data on 839 neonates who received CPR before ECMO from Jan uary 1989 to April 1995. Supplemental questionnaires on 414 infants we re returned from 64 ECMO centers regarding details of the CPR event an d subsequent neurological development. One-year neurological evaluatio ns were provided on 112 infants. Data were analyzed for statistical si gnificance using chi(2), multiple logistic regression, and Kruskal Wal lis one-way analysis of variance as applicable, with significance set at P < .05. Results: The incidence of infants requiring pre-ECMO CPR w as 13.1%. Infants who received pre-ECMO CPR had a survival rate of 60. 8% versus 81.6% survival for infants who did not require CPR (P < .000 01). Analysis of ELSO registry data showed survival was significantly associated with primary diagnosis, location of CPR, last pH level befo re ECMO, and the presence of intraventricular hemorrhage. Questionnair e data on 12-month neurological assessment showed 63% had no impairmen t and 4% were graded as severely impaired. Twelve-month neurological o utcome was significantly associated only with primary diagnosis. Concl usion: A survival rate of 60.8% with good neurological outcome at 12 m onths in 63.4% of infants suggests that CPR alone should not be a cont raindication to placing a neonate on ECMO. Copyright (C) 1997 by W.B. Saunders Company.