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Factors Associated With Survival Following Extracorporeal Cardiopulmonary Resuscitation in Children
John Nicholas Melvan1, Joel Davis2, Micheal Heard2
1Division of Cardiothoracic Surgery, Children Healthcare of Atlanta, Emory University, GA, USA.
Insights
Extracorporeal cardiopulmonary resuscitation (ECPR) can save children with refractory cardiac arrest. Survival depends on the underlying condition, but is possible even with longer CPR times. Addressing pre- and post-ECPR systemic output may reduce mortality risks.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Cardiovascular Surgery
Background:
- Refractory cardiac arrest in children poses a significant challenge.
- Extracorporeal cardiopulmonary resuscitation (ECPR) offers a potential life-saving intervention for pediatric patients unresponsive to conventional therapies.
- Understanding factors influencing survival in pediatric ECPR is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the institutional experience with ECPR in children experiencing cardiac arrest.
- To identify demographic, clinical, surgical, and ECPR-specific factors associated with mortality in this pediatric population.
- To determine the overall survival rates and factors influencing outcomes in children undergoing ECPR.
Main Methods:
- A retrospective analysis of 184 pediatric patients who underwent ECPR between 2002 and 2017.
- Data collected included demographics, cardiac and non-cardiac pathologies, surgical details, and ECPR support parameters.
- Multivariable logistic regression was employed to identify predictors of mortality.
Main Results:
- The median age was 54 days, with 85% having primary cardiac disease (74% congenital heart disease).
- ECPR followed cardiac surgery in 67% of cases. Overall survival to discharge was 43% (79/184).
- Mortality risk factors included low pre-ECPR pH, mechanical and neurologic complications, and need for renal replacement therapy.
Conclusions:
- ECPR is a valuable tool for salvaging children with refractory cardiac arrest, with survival rates varying by underlying pathology.
- Survival is achievable even with extended cardiopulmonary resuscitation (CPR) durations.
- Improving systemic output before and after ECPR initiation may help mitigate mortality risks.
Objectives:
We examined a large single-institution experience in extracorporeal cardiopulmonary resuscitation (ECPR) in children having cardiac arrest refractory to conventional resuscitation measures with focus on factors affecting survival.
Methods:
Between 2002 and 2017, 184 children underwent ECPR at our institution. We entered demographic, anatomic, clinical, surgical, and ECPR support details into a multivariable logistic regression models to determine factors associated with mortality.
Results:
Median age was 54 days (interquartile range [IQR]: 11-272). In all, 157 (85%) patients had primary cardiac disease, including 136 (74%) with congenital heart disease (71 with single ventricle). Extracorporeal cardiopulmonary resuscitation occurred following cardiac surgery in 124 (67%) patients. Median cardiopulmonary resuscitation (CPR) duration was 27 minutes (IQR: 18-40) and median support duration was 3.0 days (IQR: 1.6-5.3). Overall, ECPR was weaned in 115 (63%), with 79 (43%) surviving to hospital discharge. Survival for patients with congenital heart disease, noncongenital cardiac, and noncardiac pathologies was 44%, 71%, and 15%, respectively. On multivariable regression analysis, risk factors associated with mortality were presupport pH <7.1 (odds ratio [OR] = 3.7, 95% confidence interval [CI]: 1.11-12.41, P = .033), mechanical complications (OR = 8.33, 95% CI: 1.91-36.25, P = .005), neurologic complications (OR = 6.27, 95% CI: 1.40-28.10, P = .017), and renal replacement therapy (OR = 3.31, 95% CI: 1.03-10.66, P = .045).
Conclusions:
Extracorporeal cardiopulmonary resuscitation plays a valuable role salvaging children with refractory cardiac arrest. Survival varies with underlying pathology and can be expected even with relatively longer CPR durations. Efforts to improve systemic output before and after institution of ECPR might mitigate some of the significant risk factors for mortality.
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