NM-267
Successful wean from ECMO after pediatric out-of-hospital cardiac arrest with bystander CPR in a patient with status asthmaticus and aspiration
Kaplan I, Chilson K
Washington University School of Medicine, St. Louis, MO, USA
Case Report
We present a case of extracorporeal membrane oxygenation (ECMO) in a 7-year-old patient who received bystander CPR from an untrained family member at home for pediatric cardiac arrest. Although the patient had return of spontaneous circulation, her course was further complicated by emesis during CPR with aspiration, worsening her acute on chronic respiratory failure due to the inciting status asthmaticus.
She was eventually intubated, and after admission to the ICU, she had early initiation of ECMO. Despite this complicated course with multiple factors putting her at increased risk of severe morbidity or mortality, she had a successful six-day ECMO course with full wean, rapid extubation and displayed no neurological sequelae.
Although there is limited data to support out-of-hospital CPR for pediatric cardiac arrest, the research does support an increased survival benefit in the use of conventional CPR as opposed to compression-only CPR in this setting, and we feel this played a role in our patient’s positive outcome. Furthermore, the early initiation of ECMO in this uncommon setting of refractory status asthmaticus with evidence of aspiration, is supported in the literature as providing a positive survival benefit.
We feel that the two lessons learned are regarding the subtype of bystander CPR that is administered to the pediatric patient for out-of-hospital cardiac arrest, as well as the importance of considering early ECMO initiation in the unique setting of status asthmaticus complicated by aspiration. These concepts are worth developing and reviewing with practitioners that may be faced with similar scenarios, and thus we submit this as a novel case report.
The Cardiac Arrest Registry to Enhance Survival database of 1411 patients showed that bystander CPR was independently associated with improved overall survival and neurologically favorable survival compared with no BCPR.
It was also found that CPR subtypes administered showed notable differences in outcomes. Only conventional CPR was associated with improved survival compared with no BCPR, as opposed to compression-only CPR.
When used to support in-hospital CPR (E-CPR), ECMO is able to rescue approximately one third of patients in whom death was otherwise certain. This speaks to the importance having multi-disciplinary treatment teams that are familiar with ECMO treatment algorithms, in order to increase the likelihood of having an uncomplicated ECMO course.
Our patient had an effective reversal of her acute respiratory disease with successful wean from ECMO after bystander cardiopulmonary resuscitation. We feel that her recovery without any neurological deficits, despite multiple risk factors, warranted evaluating the subtypes of bystander CPR that may be administered in pediatric out-of-hospital cardiac arrest, as well as the importance of considering early ECMO initiation in the unique setting of status asthmaticus complicated by aspiration.
These concepts are worth reviewing by practitioners that may be faced with similar scenarios.
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