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Pediatric extracorporeal cardiopulmonary resuscitation during nights and weekends

Christopher R Burke1, Titus Chan2, Thomas V Brogan2

  • 1Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, WA, United States.

Resuscitation
|March 7, 2017
PubMed

Insights

Pediatric cardiac arrest during off-hours leads to longer extracorporeal cardiopulmonary resuscitation (ECPR) initiation times and increased central nervous system (CNS) injury. However, survival and functional outcomes are not affected by off-hours ECPR in children.

Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiovascular Surgery
  • Emergency Medicine

Background:

  • Extracorporeal cardiopulmonary resuscitation (ECPR) is a critical intervention for refractory cardiac arrest.
  • Previous research in adults suggests 24/7 surgical teams improve ECPR outcomes.
  • The impact of off-hours cardiac arrest on pediatric ECPR outcomes remains unclear.

Purpose of the Study:

  • To investigate whether the timing of cardiac arrest (weekday vs. off-hours) affects ECPR outcomes in pediatric patients.
  • To analyze the association between off-hours ECPR and time to initiation, central nervous system (CNS) injury, and survival rates.

Main Methods:

  • Retrospective review of pediatric ECPR cases at a single institution from December 2008 to August 2015.
  • Comparison of ECPR initiation times, CNS injury rates, and survival between weekday and night/weekend arrests.
  • Assessment of neurologic outcomes using the Pediatric Cerebral Performance Score at one year post-ECPR.

Main Results:

  • ECPR initiation and cannulation incision times were significantly longer during night/weekends compared to weekdays.
  • Higher rates of CNS injury were observed in the night/weekend group, with associated high mortality.
  • No significant differences were found in survival to hospital discharge, one-year survival, or neurologic outcomes based on arrest timing.

Conclusions:

  • Off-hours pediatric cardiac arrest is linked to delayed ECPR initiation and increased CNS injury.
  • Despite longer pre-ECPR support times during off-hours, pediatric survival and functional outcomes are not adversely affected.
Abstract

Keywords:
Extracorporeal cardiopulmonary resuscitationExtracorporeal life supportPediatrics

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