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Extracorporeal Cardiopulmonary Resuscitation (ECPR) in Infants and Children: A Single-Center Retrospective Study
Aqsa Shakoor1, Felipe E Pedroso1, Shimon E Jacobs1
1Department of Surgery, Columbia University Medical Center, New York, NY, USA.
Insights
Extracorporeal cardiopulmonary resuscitation (ECPR) improves survival in pediatric cardiac arrest. Higher pre-cannulation pH was linked to better outcomes, while renal replacement therapy was more common in non-survivors.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular research
- Emergency medicine
Background:
- Extracorporeal cardiopulmonary resuscitation (ECPR) is a vital intervention for pediatric cardiac arrest unresponsive to conventional treatments.
- Evaluating factors influencing ECPR outcomes is crucial for optimizing patient care.
- This study focuses on pediatric patients to understand survival determinants and complications.
Purpose of the Study:
- To identify factors associated with survival in pediatric patients undergoing ECPR.
- To analyze the incidence and impact of complications in ECPR patients.
- To compare characteristics and outcomes between survivors and non-survivors.
Main Methods:
- Retrospective review of pediatric patients (<21 years) who received ECPR from January 2010 to November 2017.
- Comparison of baseline characteristics, pre-cannulation pH, and complication rates between survivors and non-survivors.
- Analysis of survival to decannulation and discharge, and rates of renal replacement therapy, bleeding, thrombosis, and neurologic injury.
Main Results:
- Of 70 pediatric ECPR patients, 70% survived to decannulation and 54% to discharge.
- Survivors to discharge had significantly higher pre-cannulation pH (7.11 ± 0.24) than non-survivors (6.97 ± 0.21; P = .01).
- Non-survivors were more likely to receive renal replacement therapy (35.5% vs 10.8%; P = .02), with no significant differences in bleeding, thrombosis, or neurologic injury.
Conclusions:
- ECPR significantly improves survival rates in pediatric cardiac arrest patients.
- Pre-cannulation pH is a key factor associated with improved survival outcomes.
- Further research is needed to fully characterize long-term outcomes and optimize ECPR strategies.
Background:
Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used to rescue patients with cardiac arrest refractory to conventional therapy, necessitating evaluation of factors that may affect outcomes.
Methods:
A single-center retrospective review of pediatric patients (<21 years old) who underwent ECPR from January 2010 to November 2017. Comparisons between nonsurvivors and survivors, to decannulation and discharge, were made. Factors associated with survival and rate of complications were examined.
Results:
Seventy patients were supported with ECPR. Forty-nine (70%) patients survived to decannulation and 38 (54%) patients to discharge. There was no statistical difference between baseline characteristics of survivors and nonsurvivors, including age at cannulation, weight (kg), time to cannulation (minutes), and total time on extracorporeal membrane oxygenation (hours). Survivors to discharge had significantly higher pH prior to cannulation compared to nonsurvivors (7.11 ± 0.24 vs 6.97 ± 0.21, P = .01). Of all, 23.2% of patients received renal replacement therapy (RRT), 39.4% had significant bleeding, 22.5% had thrombotic complications, and 68.8% had neurologic injury on imaging studies. A greater number of nonsurvivors received RRT compared to survivors to discharge (35.5% vs 10.8%, P = .02). There were no differences in bleeding or thrombotic complications or radiographically established neurologic injury.
Conclusions:
Although ECPR effectively increases overall survival, a better characterization of long-term outcomes is needed.
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