Extracorporeal Cardiopulmonary Resuscitation (ECPR) in Infants and Children: A Single-Center Retrospective Study

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used to rescue patients with cardiac arrest refractory to conventional therapy, necessitating evaluation of factors that may affect outcomes. Methods: A single-center retrospective review of pediatric patients (<21 years old) who underwent ECPR from January 2010 to November 2017. Comparisons between nonsurvivors and survivors, to decannulation and discharge, were made. Factors associated with survival and rate of complications were examined. Results: Seventy patients were supported with ECPR. Forty-nine (70%) patients survived to decannulation and 38 (54%) patients to discharge. There was no statistical difference between baseline characteristics of survivors and nonsurvivors, including age at cannulation, weight (kg), time to cannulation (minutes), and total time on extracorporeal membrane oxygenation (hours). Survivors to discharge had significantly higher pH prior to cannulation compared to nonsurvivors (7.11 ± 0.24 vs 6.97 ± 0.21, P = .01). Of all, 23.2% of patients received renal replacement therapy (RRT), 39.4% had significant bleeding, 22.5% had thrombotic complications, and 68.8% had neurologic injury on imaging studies. A greater number of nonsurvivors received RRT compared to survivors to discharge (35.5% vs 10.8%, P = .02). There were no differences in bleeding or thrombotic complications or radiographically established neurologic injury. Conclusions: Although ECPR effectively increases overall survival, a better characterization of long-term outcomes is needed.

Outcomes of paediatric cardiac patients after 30 minutes of cardiopulmonary resuscitation prior to extracorporeal support

“…Previous studies have shown that renal and neurological injury, as part of post-arrest multi-organ dysfunction, are important predictors for poor outcomes in children undergoing extracorporeal cardiopulmonary resuscitation. 3,4,6,19,21,30 We did not find a relationship between abnormal neuroimaging during extracorporeal membrane oxygenation and mortality in our cohort; however, abnormal pupillary response had a significant strong correlation with poor outcome.…”

“…Many prior studies of extracorporeal cardiopulmonary resuscitation include patients with wide ranges of duration of chest compressions prior to cannulation, some of them including patients receiving less than 10 minutes of cardiopulmonary resuscitation prior to placement on mechanical support. 2,6,11,12,[18][19][20][21][22][23][24][25][26][27][28][29][30] Our focus on those patients receiving prolonged cardiopulmonary resuscitation provides information about a more discrete and potentially higher risk population. We focused on patients with primary cardiac disease because prior studies demonstrated increased survival with extracorporeal cardiopulmonary resuscitation and conventional cardiopulmonary resuscitation compared to non-cardiac patients.…”

“…4,33 We compared our findings with previous literature that only focus on paediatric cardiac extracorporeal cardiopulmonary resuscitation or paediatric cardiac extracorporeal membrane oxygenation with subgroup analysis of extracorporeal cardiopulmonary resuscitation patients. 2,6,11,12,[18][19][20][21][22][23][24][25][26][27][28][29][30] The Supplementary Table provides a review of paediatric extracorporeal cardiopulmonary resuscitation studies in the cardiac ICU literature. Several factors may account for differing results between our study and previous ones.…”

“…Third, our cohort focused on prolonged extracorporeal cardiopulmonary resuscitation and as such had a longer median duration of cardiopulmonary resuscitation (56 minutes) compared to the previous cardiac extracorporeal cardiopulmonary resuscitation reports where median duration ranged from 16 to 47.5 minutes 2,6,11,12,[18][19][20][25][26][27][28][29] with only four studies reporting a prolonged median duration similar to our study. 21,24,26,30 This factor would be expected to portend worse survival to our patients as prolonged cardiopulmonary resuscitation duration has been noted to be a predictor of mortality in paediatric cardiac patients undergoing extracorporeal cardiopulmonary resuscitation. 11,12,22 In our study, we observed moderate to severe neurological disability (Pediatric Cerebral Performance Categories 3 and 4) in 25% of survivors.…”

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 6. Pediatric basic life support

“…It is an active effort to issue an early warning of changes in a patient's condition by scoring blood pressure, pulse, respiratory rate, body temperature, oxygen saturation, and level of consciousness. 52 The use of a pediatric early warning score has reduced the incidence of cardiac arrest, length of stay in the hospital, and mortality as well as unplanned transfer to the pediatric intensive care unit. 53,54 However, there are not many studies on the frequency of early response as per the working hours of the rapid response team (RRT) and the patient's prognosis, and there is currently no consensus on the standard for activating the domestic RRT; therefore, continuous further study is required.…”