CPR quality and outcomes after extracorporeal life support for pediatric In-Hospital cardiac arrest

The approach to extracorporeal cardiopulmonary resuscitation (ECPR) in children. A narrative review by the paediatric ECPR working group of EuroELSO

“…13 Several GWTG-R studies report a survival of 31%–51% in different patient populations. 9,14–18 Survival in smaller cohort studies vary from 14 to 80% depending on the study population. 19,20 A meta-analysis of 28 studies showed combined hospital survival of 46% in 1348 patients.…”

“…Most ECPR is performed in children with cardiac disease who suffer an in-hospital cardiac arrest. 15,18,22 Survival in some subpopulations is notably lower, for example in the ELSO-registry, ECPR survival was only 14% in meningococcal sepsis and 30% for children with neoplasms. 19,23 In contrast, in certain situations survival can be higher, for example ECPR during cardiac catheterisation, survival to discharge was 79%.…”

“…15 This is similar to results found in the paediatric resuscitation quality (PediRes-Q) registry where 31% of all ECPR patients which reflects 67% of survivors, had a favourable neurological outcome. 18 Some studies undertook a more detailed long-term prospective follow-up. Joffe et al reviewed 14 IHCA ECPR cohort studies with total of 762 cardiac patients and reported an average survival of 49%.…”

“…64 A recent analysis of the PediRes-Q collaborative was not able to show a relationship between the quality of CPR and outcomes. 18 However, quality overall was below recommended by the AHA and thus provided room for improvement. The secondary analysis of the THAPCA-trial showed that open-chest compressions were independently associated with greater 1-year survival, possibly due to the shorter duration between start of chest compressions to initiation of ECMO.…”

High Variability in the Duration of Chest Compression Interruption is Associated With Poor Outcomes in Pediatric Extracorporeal Cardiopulmonary Resuscitation

“…ver the last 20 years, survival from pediatric in-hospital cardiac arrest (IHCA) has continued to improve, with current estimates ranging from 24% to 52% (1)(2)(3)(4)(5). Several patient and event factors including quality of chest compressions (CCs), age, duration of cardiopulmonary resuscitation (CPR) event, and duration of CC interruption (CCI) have been associated with survival in both pediatric and adult observational studies (5)(6)(7)(8). This has led to international recommendations promoting targeted depth and rate in CC while minimizing CCI to fewer than 10 seconds (9).…”