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Survival and neurocognitive outcomes in pediatric extracorporeal-cardiopulmonary resuscitation
Gonzalo Garcia Guerra1, Liliane Zorzela1, Charlene M T Robertson2
1Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Insights
Extracorporeal cardiopulmonary resuscitation (E-CPR) in children with cardiac disease shows a 43% survival rate at age 5. Survivors often experience lower intelligence quotients, with 24% exhibiting intellectual disability.
Area of Science:
- Pediatric critical care medicine
- Neonatal and pediatric extracorporeal life support
- Neurodevelopmental outcomes in critically ill children
Background:
- Extracorporeal cardiopulmonary resuscitation (E-CPR) provides life support during cardiac arrest but detailed neurocognitive outcomes are not well-described.
- Understanding long-term neurodevelopmental impacts is crucial for optimizing care for pediatric E-CPR patients.
Purpose of the Study:
- To describe the survival rates and neurocognitive outcomes in children who underwent E-CPR.
- To identify factors associated with mortality in pediatric E-CPR survivors.
Main Methods:
- A prospective cohort study included children who received E-CPR between 2000 and 2010.
- Neurocognitive follow-up used the Wechsler Preschool and Primary Scales of Intelligence at age 4.5 years, at least 6 months post-E-CPR.
Main Results:
- Fifty-five children received E-CPR; cardiac disease patients had 43% 5-year survival, while non-cardiac disease patients had no survivors.
- E-CPR survivors had a mean Full Scale Intelligence quotient (FSIQ) of 76.5, with 24% demonstrating intellectual disability (FSIQ < 70).
- Factors like pre-E-CPR mechanical ventilation, open chest CPR, prolonged CPR duration, low pH, and delayed lactate normalization were linked to increased mortality.
Conclusions:
- Pediatric E-CPR for cardiac conditions yielded a 43% survival rate at age 5.
- A significant proportion of E-CPR survivors experienced neurocognitive deficits, including intellectual disability, warranting further investigation and supportive care strategies.
Objective:
Extracorporeal Cardiopulmonary Resuscitation (E-CPR) is the initiation of extracorporeal life support during active chest compressions. There are no studies describing detailed neurocognitive outcomes of this population. We aim to describe the survival and neurocognitive outcomes of children who received E-CPR.
Methods:
Prospective cohort study. Children who received E-CPR at the Stollery Children's Hospital between 2000 and 2010 were included. Neurocognitive follow-up, including Wechsler Preschool and Primary Scales of Intelligence, was completed at the age of 4.5 years, and at a minimum of 6 months after the E-CPR admission.
Results:
Fifty-five patients received E-CPR between 2000 and 2010. Children with cardiac disease had a 49% survival to hospital discharge and 43% survival at age 5-years, with no survivors (n=4) in those with non-cardiac disease. Pediatric E-CPR survivors had a mean (SD) Full Scale Intelligence quotient (FSIQ) score of 76.5 (15.9); with 4 children (24%) having intellectual disability (defined as FSIQ over 2 standard deviations below the population mean; i.e., <70). Multiple Cox regression analysis found that mechanical ventilation prior to E-CPR, open chest CPR, longer duration of CPR, low pH and more red blood cells given on the first day of ECMO, and longer time for lactate to normalize on ECMO were associated with higher mortality at age 5-years.
Conclusion:
Pediatric patients with cardiac disease who required E-CPR had 43% survival at age 5 years. Of concern, the intelligence quotient in E-CPR survivors was significantly lower than the population mean, with 24% having intellectual disability.
