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Extracorporeal Cardiopulmonary Resuscitation in Children of Asia Pacific: A Retrospective Analysis of Extracorporeal
Gai-Ling Chen1, Ye-Ru Qiao2, Jin-Hui Ma2
1Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
Insights
Extracorporeal cardiopulmonary resuscitation (ECPR) in children in Asia Pacific shows stable survival rates but evolving patient demographics and reduced complications over time. Myocardial stunning and neurological complications are linked to increased mortality.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Surgery
- Extracorporeal Life Support
Background:
- Growing interest in Extracorporeal Membrane Oxygenation (ECMO) for Cardiopulmonary Resuscitation (CPR) in children.
- Limited data on Extracorporeal CPR (ECPR) in the Asia Pacific region presents challenges for clinical decision-making.
- Need to understand survival trends and mortality risk factors for pediatric ECPR in Asia Pacific.
Purpose of the Study:
- To analyze survival rates and demographic trends of pediatric ECPR patients in Asia Pacific from 1999-2016.
- To identify risk factors associated with in-hospital mortality in this population.
- To assess temporal changes in ECPR indications and complications.
Main Methods:
- Retrospective analysis of pediatric ECPR cases (age < 18) from the Extracorporeal Life Support Organization (ELSO) registry (1999-2016).
- Data divided into two 9-year groups (1999-2007 and 2008-2016) to evaluate temporal changes.
- Univariate and multiple logistic regression analyses used to identify mortality risk factors.
Main Results:
- Overall survival rate was 50.8% among 321 children.
- Survival rates remained similar between the two periods (43.1% vs. 52.5%).
- Increased median age and weight, with decreased proportion of congenital heart disease and cardiogenic shock over time. ECMO complications, particularly renal, decreased. Disseminated intravascular coagulation (DIC), myocardial stunning, and neurological complications were associated with higher mortality.
Conclusions:
- ECPR is increasingly applied in children in Asia Pacific due to broader indications and reduced complications.
- Myocardial stunning is an independent risk factor for decreased survival in pediatric ECPR.
- Further research into managing ECPR complications is warranted to improve outcomes.
Background:
Recent advances in extracorporeal membrane oxygenation (ECMO) have led to increasing interest in its use during cardiopulmonary resuscitation (CPR). However, decisions regarding extracorporeal CPR (ECPR) in children are difficult as a result of limited studies, especially in Asia Pacific. The objective of this study was to investigate trends in survival and demographic details for children with ECPR in Asia Pacific recorded in the Extracorporeal Life Support Organization (ELSO) registry from 1999 to 2016 and identify the risk factors associated with in-hospital mortality.
Methods:
The data of children younger than 18 years of age who received ECPR over the past 18 years in Asia Pacific were retrospectively analyzed. The data were extracted from the ELSO registry and divided into two 9-year groups (Group 1: 1999-2007 and Group 2: 2008-2016) to assess temporal changes using univariate analysis. Then, univariate and multiple logistic regression analyses were performed between survivors and nonsurvivors to identify factors independently associated with in-hospital mortality.
Results:
A total of 321 children were included in final analysis, with an overall survival rate of 50.8%. Although survival rates were similar between Group 1 and Group 2 (43.1% vs. 52.5%, χ2 = 1.67, P = 0.196), the median age (1.7 [0.3, 19.2] months for Group 1 vs. 5.6 [0.8, 64.9] months for Group 2, t = -2.93, P = 0.003) and weight (3.7 [3.0, 11.5] kg for Group 1 vs. 6.0 [3.4, 20.3] kg for Group 2, t = -3.14, P = 0.002) of children increased over time, while the proportion of congenital heart disease (75.9% for Group 1 vs. 57.8% for Group 2, χ2 = 6.52, P = 0.011) and cardiogenic shock (36.2% for Group 1 vs. 7.2% for Group 2, χ2 = 36.59, P < 0.001) decreased. Patient conditions before ECMO were worse, while ECMO complications decreased across time periods, especially renal complications. Multiple logistic regression analysis of ECMO complications showed that disseminated intravascular coagulation (DIC), myocardial stunning, and neurological complications were independently associated with increased odds of hospital mortality.
Conclusions:
The broader indications and decreased complication rates make EPCR to be applicated more and more extensive in children in Asia Pacific region. ECMO complications such as myocardial stunning are independently associated with decreased survival.
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