Identifying Prognostic Criteria for Survival after Resuscitation Assisted by Extracorporeal Membrane Oxygenation

Area of Science:

• Pediatric critical care medicine
• Cardiopulmonary resuscitation
• Extracorporeal membrane oxygenation

Background:

• Extracorporeal membrane oxygenation cardiopulmonary resuscitation (ECPR) is used to improve survival rates during cardiopulmonary resuscitation (CPR).
• Despite its use, optimal indications and organizational requirements for ECPR in children remain undefined.
• Existing literature suggests a survival to discharge rate of approximately 40% for pediatric ECPR patients.

Purpose of the Study:

• To evaluate clinical outcomes of pediatric patients following ECPR.
• To identify pre-ECPR prognostic factors associated with survival.
• To guide the appropriate indication of ECPR in pediatric cases.

Main Methods:

• Retrospective analysis of 19 pediatric patients who underwent ECPR between 2008 and 2014.
• Assessment of in-hospital mortality, including deaths during ECMO support and after weaning.
• Analysis of pre-ECPR clinical parameters (lactate, bicarbonate, pH) and resuscitation duration in survivors versus non-survivors.

Main Results:

• A high in-hospital mortality rate of 84% (16 out of 19 patients) was observed.
• Mortality occurred both during ECMO support (47%) and after successful weaning (37%).
• Survivors exhibited favorable pre-ECPR markers: lower lactate, higher bicarbonate, higher pH, and shorter resuscitation times.

Conclusions:

• ECPR in this pediatric cohort yielded poorer outcomes than anticipated.
• Pre-ECPR physiological status and resuscitation duration are potential indicators of survival.
• Further research is needed to define patient selection criteria for ECPR to optimize its benefit.