Abstract 266: Quantifying the Effect of Technological Advancements and Guidelines on Pediatric Extracorporeal Cardiopulmonary Resuscitation Survival Outcomes

Abstract

Introduction: The 2009 H1N1 pandemic resulted in a substantial increase in the use of extracorporeal cardiopulmonary resuscitation (ECPR). The concurrent release of guidelines by the French Ministry of Health also led to the standardization of ECPR protocol. We conducted a systematic review and meta-analysis to examine if the simultaneous development of guidelines and expanded usage led to an increase in survival to hospital discharge (SHD) in pediatric ECPR and to investigate if predictors of survival have changed since 2009. Methods: PubMed, SCOPUS, Google Scholar, Cochrane, and EMBASE were searched to identify studies examining survival outcome and predictors of survival for pediatric ECPR. A random-effects model was applied. Additional pre-specified subgroup analysis was performed using a fixed-effects model. A univariate meta-regression analysis was conducted. Results: The meta-analysis included 3,454 patients from 30 studies. Total survival rates have not improved in pediatric ECPR between subgroups (Mann-Whitney U test: p > 0.05). Extracorporeal membrane oxygenation (ECMO) duration for survivors was not significantly different than nonsurvivors before 2009 RR -0.02 [95% CI: -0.19 - 0.14], but was significantly lower than nonsurvivors after 2009 RR -0.32 [-0.48 - -0.15, p < 0.05]. Meta-regression analysis revealed the ratio of ECMO duration for survivors compared to non-survivors has significantly decreased from 1998 to 2020 (p < 0.05). Patient age was a significant predictor of survival pre-2009 RR but is not correlated with survival post-2009 (p > 0.05). PaO2 was significantly higher in survivors than nonsurvivors pre-2009 RR 0.15 [0.12 - 0.18, p < 0.05] but was not significantly different post-2009 (p > 0.05). End-tidal CO2, CPR duration, pre-CPR serum lactate, and pre-CPR creatinine were not significantly different (p > 0.05) between survivors and non-survivors in either pre-2009 or post-2009. Conclusion: Pediatric ECPR did not see major improvement in survival rates since 2009. In addition, predictors of survival for pediatric ECPR cases have changed over the last 10 years. As such, clinicians may be advised to rely much more heavily on recent research regarding predictors of survival in pediatric ECPR cases.

Predictors of survival for pediatric extracorporeal cardiopulmonary resuscitation: A systematic review and meta-analysis

“…This pattern was also seen in pulmonary hypertension prior to ECPR (RR = 0.44 [0.12-1.61], I 2 = 0%, P = .22). Finally, the odds of SV physiology were not significantly different in the Alsoufi, B., 2014 [25] Saudi Arabia 2007-2012 39 14 41 IHCA R Anton-Martin, P., 2020 [26] USA 2000-2013 73 26 44 IHCA R Bembea, M., 2019 [27] USA 2000-2014 593 242 41 IHCA R Beshish, A., 2018 [28] USA 2005-2015 80 40 48 IHCA R Brunner, A., 2016 [29] Switzerland 2008-2014 19 NR 16 Both R Chen, G., 2018 [30] Asia Pacific 1999-2016 321 142 51 IHCA R Chrysostomou, C., 2013 [31] USA 2006-2010 40 15 75 NR R De Mul, A., 2019 [32] Switzerland 2008-2016 55 20 25 Both R Erek, E., 2017 [33] Turkey 2010-2014 25 NR 20 IHCA R Guo, Z., 2019 [34] China 2017 11 3 36 IHCA R Huang, S., 2012 [35] Taiwan 1999-2009 54 17 46 IHCA R Jolley, M., 2014 [36] Multi 1998-2013 293 121 36 IHCA R Kane, D., 2010 [37] USA 1995-2009 172 77 51 IHCA R KendIrlI, T., 2020 [38] Turkey 2014-2017 15 8 33 IHCA R Kramer, P., 2020 [39] Germany 2005-2016 72 34 36 Both R McMullan, D., 2014 [40] Multi 1998-2010 641 257 39 NR R Melvan, J., 2020 [41] USA 2002-2017 184 92 43 NR R Philip, J., 2014 [42] USA 2005-2012 59 NR 46 IHCA R Polimenakos, A., 2017 [43] USA 2007-2011 21 NR 62 IHCA R Raymond, T., 2010 [44] USA 2000-2007 199 75 44 IHCA R Shakoor, A., 2019 [45] USA 2010-2017 70 28 54 IHCA R Shin, H., 2016 [46] SK 2013-2016 12 6 33 NR R Sivarajan, V., 2011 [47] Australia 2002-2006 37 18 38 NR R Topjian, A., 2019 [48] Multi 2009-2015 157 57 46 IHCA R Torres-Andres, F., 2018 [49] USA 2007-2015 58 23 65.5 Both R Tsukahara, K., 2014 [50] Japan 2003-2012 21 8 14 Both R Walter, E., 2011 [51] Germany 1992-2008 42 19 40 IHCA R Wolf, M., 2012 [52] USA 2002-2011 90 NR 56 IHCA R Yates, A., 2019 …”

“…[8,9] This variability, coupled with rapidly improving technological developments and increased adoption of ECPR within the last 10 years, has made a meta-analysis covering the most recent literature a necessity. [14,15] This literature review and meta-analysis analyzed predictors of survival in the most recent studies on pediatric ECPR to identify risk factors for mortality, allowing providers to make more informed decisions on patient selection and improve ECPR program effectiveness.…”