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Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients
Shu-Chien Huang1, En-Ting Wu, Yih-Sharng Chen
1Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Extracorporeal cardiopulmonary resuscitation (ECPR) offers a chance of survival for pediatric patients with in-hospital cardiac arrest. Most survivors achieved good neurologic outcomes, though early treatment and renal failure increased mortality risk.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Research
- Extracorporeal Life Support
Background:
- In-hospital cardiac arrest in children presents significant mortality challenges.
- Conventional cardiopulmonary resuscitation (CPR) has limited success in pediatric in-hospital cardiac arrest.
- Extracorporeal cardiopulmonary resuscitation (ECPR) offers an alternative advanced life support strategy.
Purpose of the Study:
- To evaluate survival and neurologic outcomes in pediatric patients undergoing ECPR for in-hospital cardiac arrest.
- To identify factors associated with survival and mortality in this patient population.
- To compare outcomes between early and later treatment cohorts.
Main Methods:
- Retrospective study at a tertiary care hospital involving pediatric patients (<18 years) receiving ECPR during cardiac arrest.
- Data collected on patient demographics, CPR duration, ECMO activation time, and post-ECPR complications.
- Survival to discharge and neurologic status (Pediatric Cerebral Performance Categories) were primary and secondary outcomes.
Main Results:
- Overall survival to hospital discharge was 41% (11 of 27 patients).
- Nonsurvivors had higher lactate levels, longer CPR durations, and increased post-ECPR renal failure.
- The later treatment cohort showed improved survival (58%) compared to the early cohort (0%), with early cohort and renal failure identified as independent mortality risk factors.
- Ten of eleven survivors had good neurologic outcomes.
Conclusions:
- ECPR can successfully rescue pediatric patients with in-hospital cardiac arrest unresponsive to conventional CPR.
- The majority of ECPR survivors achieve favorable neurologic outcomes.
- Early treatment initiation and the development of renal failure post-ECPR are significant risk factors for mortality.
Objective:
To describe survival and neurologic outcome and identify the factors associated with survival among pediatric patients following extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest.
Design:
Retrospective study.
Setting:
A university-affiliated tertiary care hospital.
Patients:
Eligible patients were < or = 18 yrs of age and received extracorporeal membrane oxygenation during active cardiopulmonary resuscitation for in-hospital cardiac arrest.
Interventions:
Extracorporeal membrane oxygenation (ECMO) during active cardiopulmonary resuscitation.
Measurements And Main Results:
The primary outcome was survival to hospital discharge. The secondary outcome was neurologic status after ECPR at hospital discharge and late follow-up. Good neurologic outcome was defined as Pediatric Cerebral Performance Categories 1, 2, and 3. Continuous variables were expressed as medians (interquartile range). We prospectively defined the early cohort (January 1999 to December 2001) and late cohort (January 2002 to January 2006) and compared the survival rates. We identified 27 ECPR events. The survival rate to hospital discharge was 41% (11 of 27). The nonsurvivors had higher pre-cardiopulmonary resuscitation serum lactate levels (14 [10.2-19.6] mmol/L vs. 8.5 [4.4-12.6] mmol/L, p < .01), longer durations of cardiopulmonary resuscitation (60 [37-81] mins vs. 45 [25-50] mins, p < .05) with longer activating time for ECMO (12.5 [7.5-33.8] mins vs. 5 [0-10] mins, p < .01), and more renal failure after ECPR (68% [11 of 16] vs. 9% [1 of 11], p < .01). The survival rate of the late cohort was better than that of the early cohort (58% [11 of 19] vs. 0% [0 of 8], p < .05). By exact multiple logistic regression analysis, the early cohort and renal failure after ECPR were two independent risk factors for mortality. Among the 11 survivors, ten had good neurologic outcomes.
Conclusions:
ECPR successfully rescued some pediatric patients who failed rescue with conventional in-hospital CPR. Good neurologic outcomes were achieved in the majority of the survivors. Early cohort and post-ECPR renal failure were associated with mortality.
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