• Complications
• Extracorporeal cardiopulmonary resuscitation
• Outcomes
• Pediatric
• Risk factors
• Survival

• Humans
• Retrospective Studies
• Male
• Female
• Extracorporeal Membrane Oxygenation/methods
• Infant
• China/epidemiology
• Child, Preschool
• Cardiopulmonary Resuscitation/methods
• Infant, Newborn
• Child
• Hospital Mortality
• Heart Arrest/therapy
• Heart Arrest/mortality
• Out-of-Hospital Cardiac Arrest/therapy
• Out-of-Hospital Cardiac Arrest/mortality
• Adolescent

• Humans
• Extracorporeal Membrane Oxygenation/methods
• Cardiopulmonary Resuscitation/methods
• Heart Arrest/therapy
• Out-of-Hospital Cardiac Arrest/therapy
• Child
• Patient Care Team

• Humans
• Medical Futility/ethics
• Lactic Acid/blood

• Humans
• Extracorporeal Membrane Oxygenation/methods
• Infant
• Male
• Female
• Cardiopulmonary Resuscitation/methods
• Child, Preschool
• Heart Arrest/therapy
• Heart Arrest/mortality
• Time Factors
• Infant, Newborn
• Child
• Treatment Outcome
• Retrospective Studies

• Cardiac arrest
• Congenital heart disease
• Functional status scale
• New morbidity
• Unfavorable outcome

• Child
• Humans
• Retrospective Studies
• Functional Status
• Cardiopulmonary Resuscitation/adverse effects
• Cardiopulmonary Resuscitation/methods
• Heart Arrest/therapy
• Heart Diseases
• Epinephrine
• Intensive Care Units, Pediatric

• Child
• Humans
• Adolescent
• Retrospective Studies
• Cardiopulmonary Resuscitation
• Heart Defects, Congenital/therapy
• Intensive Care Units, Pediatric
• Critical Care

• ECMO—extracorporeal membrane oxygenation
• ECPR program
• ECPR training
• adult ECPR
• extracorporeal resuscitation
• pediatric ECPR

• cardiac arrest
• extracorporeal cardiopulmonary resuscitation
• extracorporeal membrane oxygenation
• pediatric

• Cardiopulmonary Resuscitation
• Child
• Creatinine
• Humans
• Lactic Acid
• Nervous System Diseases
• Oxygen
• Renal Insufficiency
• Retrospective Studies
• Sepsis
• Survival Rate
• Treatment Outcome

• Advanced life support
• Bag-mask ventilation
• Basic life support
• CPR
• Cardiac arrest
• Child
• Circulatory failure
• Defibrillation
• Infant
• Oxygen
• Paediatric
• Pediatric
• Respiratory failure
• Resuscitation
• Shock

• Advanced life support
• Bag-mask ventilation
• Basic life support
• CPR
• Cardiac arrest
• Circulatory failure
• Defibrillation
• Infant
• Oxygen
• Paediatric
• Pediatric
• Respiratory failure
• Resuscitation child
• Shock

• Extracorporeal life support (ECLS)
• Extracorporeal membrane oxygenation (ECMO)
• Neonatal
• Pediatric
• Respiratory failure

• Child
• Child, Preschool
• Extracorporeal Membrane Oxygenation/methods
• Extracorporeal Membrane Oxygenation/trends
• Humans
• Infant
• Infant, Newborn
• Pediatrics/methods

• Cardiopulmonary Resuscitation
• Child
• Extracorporeal Membrane Oxygenation
• Humans
• Pediatrics
• Prospective Studies
• Retrospective Studies

• extracorporeal cardiopulmonary resuscitation
• extracorporeal life support
• hospital mergers

There has been a significant increase in the utilisation of mechanical circulatory support (MCS) devices for the management of cardiogenic shock over recent years, with new devices being developed and introduced with the aim of improving outcomes for this group of patients. MCS devices may be used as a bridge to recovery or transplantation or intended as a destination therapy. Although these devices are not without their complications, good outcomes are achieved, but not without risk of significant complications. In this article, the complications of MCS devices have been reviewed, including the intra-aortic balloon pump (IABP), Impella, TandemHeart, extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VAD)—temporary and durable.

• Impella
• Mechanical circulatory support (MCS)
• TandemHeart
• complications
• extracorporeal membrane oxygenation (ECMO)
• intra-aortic balloon pump (IABP)
• morbidity
• ventricular assist device (VAD)

• cardiac arrest
• chain of survival
• coronary heart disease
• in-hospital cardiac arrest
• survival to discharge
• ventricular fibrillation

• ECMO (extracorporeal membrane oxygenation)
• infant
• morbidity
• mortality
• neurology/neurologic injury
• pediatric

• extracorporeal cardiopulmonary resuscitation (ECPR)
• pediatric
• simulation

• advanced cardiac life support
• emergency department
• extracorporeal cardiopulmonary resuscitation
• refractory cardiac arrest

• Children
• Extracorporeal membrane oxygenation
• Morbidity
• Mortality
• Neurologic disorders
• Quality of life

• Extracorporeal membrane oxygenation
• Pediatrics
• Resuscitation
• Survival analysis

Caseloads of extracorporeal cardiopulmonary resuscitation (ECPR) have increased considerably, and hospital mortality rates remain high and unpredictable. The present study evaluated the effects of the interplay between age and prolonged low-flow duration (LFD) on hospital survival rates in elderly patients to identify subgroups that can benefit from ECPR.

Adult patients who received ECPR in our institution (2006–2016) were classified into groups 1, 2, and 3 (18–65, 65–75, and > 75 years, respectively). Data regarding ECPR and adverse events during hospitalization were collected prospectively. The primary end point was favorable neurologic outcome (cerebral performance category 1 or 2) at hospital discharge.

In total, 482 patients were divided into groups 1, 2, and 3 (70.5%, 19.3%, and 10.2%, respectively). LFDs were comparable among the groups (40.3, 41.0, and 44.3 min in groups 1, 2, and 3, P = 0.781, 0.231, and 0.382, respectively). Favorable neurologic outcome rates were nonsignificantly lower in group 3 than in the other groups (27.6%, 24.7%, and 18.4% for group 1, 2, and 3, respectively). Subgroup analysis revealed that the favorable neurologic outcome rates in group 1 were 36.7%, 25.4%, and 13.0% for LFDs of < 30, 30–60, and > 60 min, respectively (P = 0.005); in group 2, they were 32.1%, 21.2%, and 23.1%, respectively (P = 0.548); in group 3 they were 25.0%, 20.8%, and 0.0%, respectively (P = 0.274).

On emergency consultation for ECPR, age and low-flow duration should be considered together to predict neurologic outcome.

The online version of this article (10.1007/s00134-018-5496-y) contains supplementary material, which is available to authorized users.

• Age
• Cardiopulmonary resuscitation
• Extracorporeal cardiopulmonary resuscitation
• Extracorporeal membrane oxygenation
• Low-flow duration

• extracorporeal membrane oxygenation
• neurodevelopmental outcomes
• neurocognitive outcomes
• picu
• pediatrics
• intensive care unit

• Adolescent
• Child
• Child, Preschool
• Extracorporeal Membrane Oxygenation/adverse effects
• Humans
• Infant
• Infant, Newborn
• Neurocognitive Disorders/epidemiology
• Neurocognitive Disorders/etiology
• Outcome Assessment, Health Care/statistics & numerical data
• Quality of Life

• K23 NS076674 NINDS NIH HHS

• cardiac arrest
• cardiopulmonary resuscitation
• congenital heart disease
• extracorporeal membrane oxygenation
• pediatrics

• Adrenergic beta-Agonists/administration & dosage
• Cardiopulmonary Resuscitation/statistics & numerical data
• Child
• Cross-Sectional Studies
• Epinephrine/administration & dosage
• Extracorporeal Membrane Oxygenation/statistics & numerical data
• Guideline Adherence/statistics & numerical data
• Heart Diseases/therapy
• Hospitals, Pediatric/statistics & numerical data
• Humans
• Practice Patterns, Physicians'/statistics & numerical data
• Standard of Care/statistics & numerical data

• K23 NS075363 NINDS NIH HHS
• K23 NS076674 NINDS NIH HHS

• ECMO
• Myocarditis
• Risk factors
• Shock, cardiogenic
• Treatment outcome

Continuous renal replacement therapy (CRRT) is an excellent method used to remove fluid and solutes. It may also reduce the systemic inflammatory response for patients on extracorporeal membrane oxygenation (ECMO) support. The objective of this report is to describe a case where CRRT in combination with ECMO was insufficient to control hyperkalemia.

We report the case of an adolescent patient with refractory symptomatic hyperkalemia due to substantial rhabdomyolysis in which CRRT insufficiently cleared the patient’s excess potassium.

Intermittent hemodialysis (IHD) was added and proved successful. The patient was weaned off ECMO, CRRT, and IHD, and his cardiac and renal function eventually normalized.

Two important lessons can be learned from this case report: (1) If CRRT is insufficient in achieving a desirable potassium balance, additional IHD should be considered and (2) separate IHD access should be considered to improve efficacy.

• CRRT
• ECMO
• IHD
• hyperkalemia
• pediatrics

• extracorporeal membrane oxygenation
• neonate
• persistent pulmonary hypertension of neonate
• respiratory failure

Extracorporeal cardiopulmonary resuscitation (ECPR) is the use of rapid deployment venoarterial (VA) extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR). Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30–60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates. Percutaneous cannulation where feasible is rapid and can be performed by nonsurgeons (emergency physicians, intensivists, cardiologists, and interventional radiologists). Modern extracorporeal systems are easy to prime and manage and are technically easy to manage with proper training and experience. ECPR can be deployed in the emergency department for out-of-hospital arrest or in various inpatient units for in-hospital arrest. ECPR should be considered for patients with refractory cardiac arrest in hospitals with an existing extracorporeal life support program, able to provide rapid deployment of support, and with resources to provide postresuscitation evaluation and management.

• Extracorporeal life support (ECLS)
• Extracorporeal membrane oxygenation (ECMO)
• Injury severity score (ISS)
• Major trauma
• Outcome

• ARDS
• community-acquired pneumonia
• early rescue
• extracorporeal life support
• infections
• sepsis
• shock

Cardiogenic shock which corresponds to an acute state of circulatory failure due to impairment of myocardial contractility is a very rare disease in children, even more than in adults. To date, no international recommendations regarding its management in critically ill children are available. An experts’ recommendations in adult population have recently been made (Levy et al. Ann Intensive Care 5(1):52, 2015; Levy et al. Ann Intensive Care 5(1):26, 2015). We present herein recommendations for the management of cardiogenic shock in children, developed with the grading of recommendations’ assessment, development, and evaluation system by an expert group of the Groupe Francophone de Réanimation et Urgences Pédiatriques (French Group for Pediatric Intensive Care and Emergencies). The recommendations cover four major fields of application such as: recognition of early signs of shock and the patient pathway, management principles and therapeutic goals, monitoring hemodynamic and biological variables, and circulatory support (indications, techniques, organization, and transfer criteria). Major principle care for children with cardiogenic shock is primarily based on clinical and echocardiographic assessment. There are few drugs reported as effective in childhood in the medical literature. The use of circulatory support should be facilitated in terms of organization and reflected in the centers that support these children. Children with cardiogenic shock are vulnerable and should be followed regularly by intensivist cardiologists and pediatricians. The experts emphasize the multidisciplinary nature of management of children with cardiogenic shock and the importance of effective communication between emergency medical assistance teams (SAMU), mobile pediatric emergency units (SMUR), pediatric emergency departments, pediatric cardiology and cardiac surgery departments, and pediatric intensive care units.

Veno-arterial extracorporeal membrane oxygenation (ECMO-CPR) is a life-saving rescue for selected patients when standard cardiopulmonary resuscitation fails. The use is increasing although the treatment modality is not fully established. Resuscitated patients typically develop a detrimental early post-arrest cardiac dysfunction that also deserves main emphasis. The present study investigates an ECMO-CPR strategy in pigs and assesses early post-arrest left ventricular function in detail. We hypothesised that a significant dysfunction could be demonstrated with this model using magnetic resonance imaging (MRI), not previously used early post-arrest.

In eight anaesthetised pigs, a 15-min ventricular fibrillation was resuscitated by an ECMO-CPR strategy of 150-min veno-arterial ECMO aiming at high blood flow rate and pharmacologically sustained aortic blood pressure and pulse pressure of 50 and 15 mmHg, respectively. Pre-arrest cardiac MRI and haemodynamic measurements of left ventricular function were compared to measurements performed 300-min post-arrest.

All animals were successfully resuscitated, weaned from the ECMO circuit, and haemodynamically stabilised post-arrest. Cardiac output was maintained by an increased heart rate post-arrest, but left ventricular ejection fraction and stroke volume were decreased by approximately 50 %. Systolic circumferential strain and mitral annular plane systolic excursion as well as the left ventricular wall thickening were reduced by approximately 50–70 % post-arrest. The diastolic function variables measured were unchanged.

The present animal study demonstrates a successful ECMO-CPR strategy resuscitating long-lasting cardiac arrest with adequate post-arrest haemodynamic stability. The associated severe systolic left ventricular dysfunction could be charted in detail by MRI, a valuable tool for future cardiac outcome assessments in resuscitation research.

Institutional protocol number: FOTS 4611/13.

The online version of this article (doi:10.1186/s40635-015-0061-2) contains supplementary material, which is available to authorized users.

• Cardiopulmonary resuscitation
• Critical care
• Extracorporeal life support
• Neurocognitive outcomes

• Alberta/epidemiology
• Cardiopulmonary Resuscitation/methods
• Child, Preschool
• Cognition/physiology
• Extracorporeal Membrane Oxygenation/methods
• Female
• Follow-Up Studies
• Heart Arrest/complications
• Heart Arrest/mortality
• Heart Arrest/therapy
• Humans
• Male
• Neurocognitive Disorders/epidemiology
• Neurocognitive Disorders/etiology
• Prognosis
• Prospective Studies
• Survival Rate/trends
• Time Factors

• Anticoagulation
• Continuous renal replacement therapy (CRRT)
• Extracorporeal life support (ECLS)
• Extracorporeal membrane oxygenation (ECMO)
• Neonatal critical care
• Pediatric critical care