Comparative Review of Outcomes in Patients With Congenital Heart Disease Requiring Cardiopulmonary Support for Failure to Wean From Cardiopulmonary Bypass or for Refractory Sudden Cardiac Arrest

Abstract

Background: We reviewed the outcomes of patients who underwent cardiopulmonary support (CPS) for either refractory sudden cardiac arrest or failure to wean from cardiopulmonary bypass (CPB). Methods: Between January 2005 and July 2013, 37 patients with congenital heart disease (CHD) underwent 39 instances of CPS for sudden cardiac arrest as extracorporeal cardiopulmonary resuscitation (E-CPR; group I, n = 19) or for failure to wean from CPB (group II, n = 20). Univariate analyses determined which variables differed among the groups and which had significant association with hospital survival. Binary logistic regression determined the significant associations in a multivariable model. Results: Overall 30-day and hospital survival were 76.9% (30) and 69.2% (27), respectively. For groups I and II, hospital survival was 68.4% (13) and 70.0% (14), respectively. Variables associated with mortality in the univariate analysis included hours on CPS ( P = .045), initial aspartate aminotransferase (AST) level on CPS ( P = .007), and bicarbonate 24 hours on CPS ( P = .004). Logistic regression showed single-ventricle physiology ( P = .05), initial AST level on CPS ( P = .03), and lower bicarbonate 24 hours on CPS ( P = .026) to be significantly associated with mortality. Conclusions: Comparable rates of survival to discharge can be obtained when CPS is initiated for E-CPR or for failure to wean from CPB in resuscitating patients with CHD. Hepatic and renal factors indicative of inadequate early tissue perfusion, single-ventricle physiology, and lower bicarbonate level are factors associated with poor outcome.