Extracorporeal CPR Improves Pediatric Survival

Study Questions:

Are pediatric patients receiving extracorporeal membrane oxygenation (ECMO) as a cardiopulmonary resuscitation (E-CPR) strategy following in-hospital cardiac arrest more likely to survive and have favorable neurologic outcome than patients receiving only conventional CPR (C-CPR)?

Methods:

Data from January 2000–December 2011 were sourced from the American Heart Association’s Get With the Guidelines–Resuscitation registry for this observational study. Included patients were <18 years old and received ≥10 minutes of CPR. The primary outcome was survival to hospital discharge. The likelihood of the outcome was modeled using two methods: conditional logistic regression and propensity score-based matching.

Results:

A total of 3,756 patients were included in the analysis. A notable difference in the baseline characteristics was that most of the patients receiving E-CPR were cardiac surgical patients (59%) versus only 20% of the C-CPR patients. Survival to hospital discharge was 40% for E-CPR and 27% for C-CPR. Conditional logistic regression and propensity score analysis demonstrated: 1) higher odds of survival to hospital discharge with E-CPR (odds ratio [OR], 2.76; 95% confidence interval [CI], 2.08-3.65) and (OR, 1.7; 95% CI 1.33-2.18) respectively; and 2) higher odds of favorable neurologic outcome with E-CPR (OR, 2.64; 95% CI, 1.91-3.67) and (OR, 1.78; 95% CI, 1.31-2.41), respectively. These improved odds held true even when cardiac surgical patients were excluded from the analysis.

Conclusions:

ECMO use as a resuscitation strategy improves survival and neurologic outcomes in patients requiring ≥10 minutes of CPR for in-hospital cardiac arrest.

Perspective:

Survival after pediatric in-hospital cardiac arrest is low: 27% overall. ECMO used as a resuscitation strategy improves these outcomes, but only to a survival of 40% and a favorable neurologic outcome in 27%. ECMO is a complex and expensive addition to the resuscitation armamentarium of the hospital physician. Assessment of the cost-effectiveness of E-CPR is a logical next step in assessing the potential for widespread implementation of more proactive E-CPR utilization.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias

Keywords: Arrhythmias, Cardiac, Cardiac Surgical Procedures, Cardiopulmonary Resuscitation, Extracorporeal Membrane Oxygenation, Heart Arrest, Patient Discharge, Pediatrics, Resuscitation, Survival


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